Provider Demographics
NPI:1235910035
Name:SAYRE, MELISSA BETH
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BETH
Last Name:SAYRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 LITTLE SWEDEN SE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-5503
Mailing Address - Country:US
Mailing Address - Phone:320-491-7287
Mailing Address - Fax:
Practice Address - Street 1:2404 LITTLE SWEDEN SE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-5503
Practice Address - Country:US
Practice Address - Phone:320-491-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN169911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical