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General NPI Number Information
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NPI Number | 1497157218
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Entity Type | Individual
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Provider Name | JETTA MEADOWS ASW
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Gender | Female
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 149 N MAIN ST SUITE # 210
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City | LAKEPORT
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State | CA
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Zip | 95453-4832
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Country | US
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Telephone | 707-262-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 4520 HIGH CT
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City | KELSEYVILLE
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State | CA
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Zip | 95451-9347
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Country | US
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Telephone | 530-864-5283
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | CA
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