1306314661 NPI number — JENNIFER WENTZ MEADOR MS, LPC, NCC

Table of content: DREW PARKER (NPI 1154090181)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306314661 NPI number — JENNIFER WENTZ MEADOR MS, LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEADOR
Provider First Name:
JENNIFER
Provider Middle Name:
WENTZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306314661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 LAKESHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENTERPRISE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36330-7804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-641-1477
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1708 COUNTY ROAD 32
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACHIN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36910-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-641-1477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  657081 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2420 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 3973 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: PC013684 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC.0017271 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: TPMC1060 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)