Provider Demographics
NPI:1922290378
Name:JOHNSON, MELINDA LEE (CHA/P)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CHA/P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NELSON LAGOON
Mailing Address - State:AK
Mailing Address - Zip Code:99571
Mailing Address - Country:US
Mailing Address - Phone:907-989-2202
Mailing Address - Fax:907-989-2245
Practice Address - Street 1:3380 C ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3949
Practice Address - Country:US
Practice Address - Phone:907-277-1440
Practice Address - Fax:907-277-1446
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist