Provider Demographics
NPI:1437840717
Name:LOWRY, MELINDA MARIE
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MARIE
Last Name:LOWRY
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 1:6800 78TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2758
Mailing Address - Country:US
Mailing Address - Phone:651-347-1760
Mailing Address - Fax:612-314-0350
Practice Address - Street 1:10028 PIERCE ST NE UNIT A
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3786
Practice Address - Country:US
Practice Address - Phone:763-218-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral