Provider Demographics
NPI:1730493057
Name:WIKE, MEREDITH
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:WIKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 S WINCHESTER BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4328
Mailing Address - Country:US
Mailing Address - Phone:804-436-2222
Mailing Address - Fax:831-288-8763
Practice Address - Street 1:1361 S WINCHESTER BLVD STE 109
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4328
Practice Address - Country:US
Practice Address - Phone:804-436-2222
Practice Address - Fax:831-288-8763
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
VA1-09-5236103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst