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MIELKE GROUP, INC.

Clinical Neuropsychologist

Jacksonville, Florida

Provider NPI: 1013161223

Organization Information:
Organization Name:  MIELKE GROUP, INC.
Organization is not Subpart
Authorized Official:  JEANNINE B. MIELKE  OWNER  904-6072079

Practice Location:
3 SHIRCLIFF WAY SUITE #333 JACKSONVILLE, FL 32204 US
Tel: 904-607-2079  Fax: 904-384-0094

Business Mailing Address:
7177 AUGUSTA DR  FLEMING ISLAND, FL 32003 US
Tel: 904-607-2079  Fax: 904-384-0094

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
FLPY6839

Other Provider Identifiers:

IssuerNumberStateType
BLUE CROSS AND BLUE SHIELD OF FLORIDA74187FL01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS FL - Page 1

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