Provider Demographics
NPI:1376701599
Name:OLDHAM, MELINDA E (MS, LCSW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:E
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 S 5TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2316
Mailing Address - Country:US
Mailing Address - Phone:217-523-5669
Mailing Address - Fax:
Practice Address - Street 1:1204 S 5TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2316
Practice Address - Country:US
Practice Address - Phone:217-523-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0127231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical