Provider Demographics
NPI:1164968715
Name:FLICKINGER, MELINDA J (PLCSW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:J
Last Name:FLICKINGER
Suffix:
Gender:F
Credentials:PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PFEIFFER AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-5047
Mailing Address - Country:US
Mailing Address - Phone:660-665-4635
Mailing Address - Fax:660-665-4612
Practice Address - Street 1:105 PFEIFFER AVE
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-5047
Practice Address - Country:US
Practice Address - Phone:660-665-4635
Practice Address - Fax:660-665-4612
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140350651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical