Provider Demographics
NPI:1992245740
Name:MEYERINK, SHELBY ANN (MED, BCBA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ANN
Last Name:MEYERINK
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 ADVENTURELAND DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2237
Mailing Address - Country:US
Mailing Address - Phone:605-202-0773
Mailing Address - Fax:515-957-3380
Practice Address - Street 1:1625 ADVENTURELAND DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-2237
Practice Address - Country:US
Practice Address - Phone:605-202-0773
Practice Address - Fax:515-957-3380
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1-16-24812103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst