Provider Demographics
NPI:1417528126
Name:PASCOE, MELISSA (LGSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PASCOE
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 DAYTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6189
Mailing Address - Country:US
Mailing Address - Phone:612-404-8485
Mailing Address - Fax:
Practice Address - Street 1:4525 WHITE BEAR PKWY STE 119
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-7666
Practice Address - Country:US
Practice Address - Phone:612-467-9212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN293131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical