Provider Demographics
NPI:1891023982
Name:KOSKELA, MELINDA KAY (PCC)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:KAY
Last Name:KOSKELA
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1921
Mailing Address - Country:US
Mailing Address - Phone:419-656-3900
Mailing Address - Fax:419-734-2123
Practice Address - Street 1:318 MADISON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1921
Practice Address - Country:US
Practice Address - Phone:419-635-5695
Practice Address - Fax:419-734-2123
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0007445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193287Medicaid