Provider Demographics
NPI:1326426008
Name:VANDERPOL-BAILEY, MELANIE JEAN (LCSW-PIP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:JEAN
Last Name:VANDERPOL-BAILEY
Suffix:
Gender:F
Credentials:LCSW-PIP
Other - Prefix:MRS
Other - First Name:MELANIE
Other - Middle Name:JEAN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2109 S NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3730
Mailing Address - Country:US
Mailing Address - Phone:605-334-2696
Mailing Address - Fax:605-339-9944
Practice Address - Street 1:2109 S NORTON AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-3730
Practice Address - Country:US
Practice Address - Phone:605-334-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD30021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical