Provider Demographics
NPI:1467090928
Name:BOOY, MELINDA ABBYGAIL
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ABBYGAIL
Last Name:BOOY
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 1:5299 WILHELM RD NW
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49676-9518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5299 WILHELM RD NW
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:MI
Practice Address - Zip Code:49676-9518
Practice Address - Country:US
Practice Address - Phone:989-348-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker