Provider Demographics
NPI:1275233736
Name:GRISWOLD, MELIESA HOPE (LMSW)
Entity Type:Individual
Prefix:
First Name:MELIESA
Middle Name:HOPE
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:HOPE
Other - Middle Name:
Other - Last Name:GRISWOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:919 S WHIPPOORWILL RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3627
Mailing Address - Country:US
Mailing Address - Phone:316-619-6622
Mailing Address - Fax:
Practice Address - Street 1:545 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3645
Practice Address - Country:US
Practice Address - Phone:316-260-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12959104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker