Provider Demographics
NPI:1972668341
Name:SCHENK, MELINDA WALDER (MSW)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:WALDER
Last Name:SCHENK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:GAIL
Other - Last Name:WALDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:628 MURIEL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4137
Mailing Address - Country:US
Mailing Address - Phone:301-770-3463
Mailing Address - Fax:
Practice Address - Street 1:628 MURIEL ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4137
Practice Address - Country:US
Practice Address - Phone:301-770-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD055451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD490417Medicare ID - Type Unspecified