Provider Demographics
NPI:1306204730
Name:GOWDY, MELANIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:GOWDY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 142373
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-0373
Mailing Address - Country:US
Mailing Address - Phone:314-438-0811
Mailing Address - Fax:314-438-0822
Practice Address - Street 1:9451 LACKLAND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-3627
Practice Address - Country:US
Practice Address - Phone:314-438-0811
Practice Address - Fax:314-438-0822
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-30
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0013649Medicaid