Provider Demographics
NPI:1548387061
Name:RYDE, MELINDA KAY (MSW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAY
Last Name:RYDE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N GROESBECK HWY UNIT 175-F
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-1562
Mailing Address - Country:US
Mailing Address - Phone:586-627-0024
Mailing Address - Fax:586-627-0027
Practice Address - Street 1:175 N GROESBECK HWY UNIT 175-F
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043
Practice Address - Country:US
Practice Address - Phone:586-627-0024
Practice Address - Fax:586-627-0027
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010468841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical