=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164559944
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MENG AI LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 09/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 W KIRKWOOD AVE STE 210
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47404-6133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-333-1988
-----------------------------------------------------
Fax | 812-822-3159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 W KIRKWOOD AVE STE 210
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47404-6133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-333-1988
-----------------------------------------------------
Fax | 812-822-3159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 34004371A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------