Provider Demographics
NPI:1023463486
Name:KORCH, MELISSA HUPPIN (EDS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:HUPPIN
Last Name:KORCH
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LEAH
Other - Last Name:HUPPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:5502 34TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2305
Mailing Address - Country:US
Mailing Address - Phone:206-420-7345
Mailing Address - Fax:
Practice Address - Street 1:5502 34TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2305
Practice Address - Country:US
Practice Address - Phone:206-420-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA499632H103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool