Provider Demographics
NPI:1013298983
Name:BURCHFIELD, MELINDA SUE (MSW,LCSW, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:SUE
Last Name:BURCHFIELD
Suffix:
Gender:F
Credentials:MSW,LCSW, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17472 BUSINESS 60
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-8577
Mailing Address - Country:US
Mailing Address - Phone:417-451-5663
Mailing Address - Fax:
Practice Address - Street 1:1515 HAZEL ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2850
Practice Address - Country:US
Practice Address - Phone:417-358-0188
Practice Address - Fax:417-358-0189
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110287581041C0700X
MO10421039174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174N00000XOther Service ProvidersLactation Consultant, Non-RN