Provider Demographics
NPI:1245734326
Name:BARNES, MELINDA MARIE (MT-BC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MARIE
Last Name:BARNES
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3846 S 4025 W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-9676
Mailing Address - Country:US
Mailing Address - Phone:801-725-9297
Mailing Address - Fax:
Practice Address - Street 1:3846 S 4025 W
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-9676
Practice Address - Country:US
Practice Address - Phone:801-725-9297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9480115-4010225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist