Provider Demographics
NPI:1871747584
Name:OUIMETTE, MEREDITH E (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:E
Last Name:OUIMETTE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1572
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1364
Mailing Address - Country:US
Mailing Address - Phone:770-591-9552
Mailing Address - Fax:770-516-4191
Practice Address - Street 1:335 PARKWAY 575
Practice Address - Street 2:SUITE #220
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6433
Practice Address - Country:US
Practice Address - Phone:770-591-9552
Practice Address - Fax:770-516-4191
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4001103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst