Provider Demographics
NPI:1275083685
Name:SHIGEMATSU, MELISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SHIGEMATSU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3481 UNIVERSITY DR S STE 104
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6235
Mailing Address - Country:US
Mailing Address - Phone:701-353-9238
Mailing Address - Fax:701-205-1221
Practice Address - Street 1:3481 UNIVERSITY DR S STE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6235
Practice Address - Country:US
Practice Address - Phone:701-353-9238
Practice Address - Fax:701-205-1221
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other