Provider Demographics
NPI:1942631866
Name:STADERMAN, MELANIE LYNN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:LYNN
Last Name:STADERMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 OLD ELIZABETHTOWN RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-9413
Mailing Address - Country:US
Mailing Address - Phone:270-723-1220
Mailing Address - Fax:
Practice Address - Street 1:928 OLD ELIZABETHTOWN RD
Practice Address - Street 2:SUITE 7
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-9413
Practice Address - Country:US
Practice Address - Phone:270-723-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-08-030106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist