Provider Demographics
NPI:1578604179
Name:PATTERSON, MELINDA PETTINGILL (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MELINDA
Middle Name:PETTINGILL
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:PETTINGILL
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1983 S 1600 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3846
Mailing Address - Country:US
Mailing Address - Phone:801-755-9793
Mailing Address - Fax:
Practice Address - Street 1:1291 S 1100 E STE 201
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105
Practice Address - Country:US
Practice Address - Phone:180-175-5979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6365751-35011041C0700X
UT6365751-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical