Provider Demographics
NPI:1396213815
Name:KINZNER, MELISSA LINDA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LINDA
Last Name:KINZNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 CHERRYWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2667
Mailing Address - Country:US
Mailing Address - Phone:360-473-9514
Mailing Address - Fax:
Practice Address - Street 1:1202 BLACK LAKE BLVD SW STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-7208
Practice Address - Country:US
Practice Address - Phone:360-819-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health