Provider Demographics
NPI:1427603075
Name:ANDERSON, MELISSA DAWN (CDCA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-1365
Mailing Address - Country:US
Mailing Address - Phone:937-981-7701
Mailing Address - Fax:
Practice Address - Street 1:134 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1365
Practice Address - Country:US
Practice Address - Phone:937-981-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.168858171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator