Provider Demographics
NPI:1275720245
Name:WAYMAN, MELISSA ROSE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:WAYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 FOLSOM BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3257
Mailing Address - Country:US
Mailing Address - Phone:916-388-6400
Mailing Address - Fax:916-388-6434
Practice Address - Street 1:8801 FOLSOM BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3257
Practice Address - Country:US
Practice Address - Phone:916-388-6400
Practice Address - Fax:916-388-6434
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool