Provider Demographics
NPI:1477706885
Name:MARTINI-TISCHER, MELISSA LYNN (MA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:MARTINI-TISCHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 2ND AVE SW STE 117
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1500
Mailing Address - Country:US
Mailing Address - Phone:612-296-8901
Mailing Address - Fax:
Practice Address - Street 1:303 CREDIT UNION DR STE 12A
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-4010
Practice Address - Country:US
Practice Address - Phone:612-296-8901
Practice Address - Fax:651-390-6178
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health