Provider Demographics
NPI:1356460497
Name:HAYWARD, MELINDA (MED)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11460 S PREAKNESS DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-6129
Mailing Address - Country:US
Mailing Address - Phone:815-267-3403
Mailing Address - Fax:815-828-0644
Practice Address - Street 1:11460 S PREAKNESS DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-6129
Practice Address - Country:US
Practice Address - Phone:815-267-3403
Practice Address - Fax:815-828-0644
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist