Provider Demographics
NPI:1285043497
Name:SEIBERT, MELINDA
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:HOUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:338 S MAIN
Mailing Address - Street 2:
Mailing Address - City:WEST UNITY
Mailing Address - State:OH
Mailing Address - Zip Code:43570
Mailing Address - Country:US
Mailing Address - Phone:419-551-0805
Mailing Address - Fax:
Practice Address - Street 1:338 S MAIN
Practice Address - Street 2:
Practice Address - City:WEST UNITY
Practice Address - State:OH
Practice Address - Zip Code:43570
Practice Address - Country:US
Practice Address - Phone:419-551-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400769900608172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker