Provider Demographics
NPI:1669494076
Name:BENEDICT, MELANIE M (MOFSED)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:M
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:MOFSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 STATE ROUTE 113
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9708
Mailing Address - Country:US
Mailing Address - Phone:419-483-3918
Mailing Address - Fax:419-484-1203
Practice Address - Street 1:5433 STATE ROUTE 113
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9708
Practice Address - Country:US
Practice Address - Phone:419-483-3918
Practice Address - Fax:419-484-1203
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.3258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000185492OtherANTHEM BLUE CROSS PIN