Provider Demographics
NPI:1245423177
Name:GIANNAKOPOULOS, MELISSA ANN (MED, CRC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:GIANNAKOPOULOS
Suffix:
Gender:F
Credentials:MED, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-0624
Mailing Address - Country:US
Mailing Address - Phone:330-220-4892
Mailing Address - Fax:330-220-5681
Practice Address - Street 1:875 SEASONS PASS DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4753
Practice Address - Country:US
Practice Address - Phone:330-220-4892
Practice Address - Fax:330-220-5681
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-036640171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator