Provider Demographics
NPI:1598927774
Name:MELLENKAMP, AMBER HOPE
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:HOPE
Last Name:MELLENKAMP
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 1:4009 WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-8366
Mailing Address - Country:US
Mailing Address - Phone:606-301-1824
Mailing Address - Fax:606-759-5045
Practice Address - Street 1:4009 WINDSONG DR
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8366
Practice Address - Country:US
Practice Address - Phone:606-301-1824
Practice Address - Fax:606-564-9577
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist