Provider Demographics
NPI:1710743489
Name:ROBERTS, MELISSA MARIE (BSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:6424 W BEECH ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-9435
Mailing Address - Country:US
Mailing Address - Phone:231-750-9273
Mailing Address - Fax:
Practice Address - Street 1:397 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:MI
Practice Address - Zip Code:49421-8562
Practice Address - Country:US
Practice Address - Phone:231-750-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020868471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical