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General NPI Number Information
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NPI Number | 1477746436
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Entity Type | Individual
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Provider Name | MATTHEW JAMES MEINHARD LISW CADC
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Gender | Male
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 6900 UNIVSERSITY AVE STE. 135
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City | WINDSOR HEIGHTS
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State | IA
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Zip | 50324-1505
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Country | US
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Telephone | 515-243-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 2504 KINGSTON DR
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City | AMES
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State | IA
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Zip | 50010-1142
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Country | US
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Telephone | 515-233-8613
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 07030
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 02437
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License Number State | IA
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