Provider Demographics
NPI:1245580141
Name:HARRISON, MELISSA GAYLE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:GAYLE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 W PRATT BLVD
Mailing Address - Street 2:UNIT 1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4347
Mailing Address - Country:US
Mailing Address - Phone:760-637-9828
Mailing Address - Fax:
Practice Address - Street 1:1218 W PRATT BLVD
Practice Address - Street 2:UNIT 1N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4347
Practice Address - Country:US
Practice Address - Phone:760-637-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist