Provider Demographics
NPI:1851423636
Name:THOMPSON-CLARKE, MELANIE (MAC, LICAC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:THOMPSON-CLARKE
Suffix:
Gender:F
Credentials:MAC, LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WINSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST BALDWIN
Mailing Address - State:ME
Mailing Address - Zip Code:04024
Mailing Address - Country:US
Mailing Address - Phone:207-839-5529
Mailing Address - Fax:
Practice Address - Street 1:510 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1339
Practice Address - Country:US
Practice Address - Phone:207-839-5529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC225171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist