Provider Demographics
NPI:1124009154
Name:ST BERNARD, MELANIE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ANN
Last Name:ST BERNARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-2033
Mailing Address - Country:US
Mailing Address - Phone:517-423-6889
Mailing Address - Fax:517-423-6890
Practice Address - Street 1:308 S MAUMEE ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-2033
Practice Address - Country:US
Practice Address - Phone:517-423-6889
Practice Address - Fax:517-423-6890
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680D645180OtherBCBS