Provider Demographics
NPI:1164128005
Name:PRICE, MELISSA VICTORIA (INDEPENDENT DSP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:VICTORIA
Last Name:PRICE
Suffix:
Gender:F
Credentials:INDEPENDENT DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12203 WIKEL RD
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846-9441
Mailing Address - Country:US
Mailing Address - Phone:419-577-2839
Mailing Address - Fax:
Practice Address - Street 1:12203 WIKEL RD
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:OH
Practice Address - Zip Code:44846-9441
Practice Address - Country:US
Practice Address - Phone:419-577-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0451690251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0451690OtherDEPARTMENT OF DEVELOPMENTAL DISABILITY