Provider Demographics
NPI:1093498479
Name:KENNEDY, MELISSA (CAMA, QMHA-R, CADC-R)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CAMA, QMHA-R, CADC-R
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2210 N ELDORADO AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6418
Mailing Address - Country:US
Mailing Address - Phone:541-883-1030
Mailing Address - Fax:
Practice Address - Street 1:725 WASHBURN WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-3648
Practice Address - Country:US
Practice Address - Phone:541-883-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist