Provider Demographics
NPI:1801915202
Name:MEDDERS, BRENDA (MSW)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:MEDDERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11728 AARON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-3929
Mailing Address - Country:US
Mailing Address - Phone:904-757-4805
Mailing Address - Fax:904-751-3805
Practice Address - Street 1:11728 AARON RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-3929
Practice Address - Country:US
Practice Address - Phone:904-757-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker