Provider Demographics
NPI:1619986957
Name:MELTON, JEANNE (MSW)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:MELTON
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 1:6003 W OVERLAND RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-3075
Mailing Address - Country:US
Mailing Address - Phone:208-345-8861
Mailing Address - Fax:209-345-2077
Practice Address - Street 1:6003 W OVERLAND RD STE 105
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3075
Practice Address - Country:US
Practice Address - Phone:208-345-8861
Practice Address - Fax:209-345-2077
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 208104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker