Provider Demographics
NPI:1699504969
Name:MEREDITH, ROBIN E (STNA, CDCA, PTC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:E
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:STNA, CDCA, PTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FURNACE ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5023
Mailing Address - Country:US
Mailing Address - Phone:440-381-5779
Mailing Address - Fax:
Practice Address - Street 1:115 FURNACE ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5023
Practice Address - Country:US
Practice Address - Phone:440-381-5779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7000560495RM246RP1900X
OH602688510723376K00000X
OH189997101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No376K00000XNursing Service Related ProvidersNurse's Aide