Provider Demographics
NPI:1568802619
Name:HEDSTROM, MELISSA (MS NTP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HEDSTROM
Suffix:
Gender:F
Credentials:MS NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 MONTEREY DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-8800
Mailing Address - Country:US
Mailing Address - Phone:503-983-4744
Mailing Address - Fax:
Practice Address - Street 1:5423 MONTEREY DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-8800
Practice Address - Country:US
Practice Address - Phone:503-983-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education