Provider Demographics
NPI:1245909498
Name:FLANDERS, MELODY
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:
Last Name:FLANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:VEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 LEFFINGWELL AVE NE APT 504
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6405
Mailing Address - Country:US
Mailing Address - Phone:616-422-8509
Mailing Address - Fax:
Practice Address - Street 1:3300 36TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2810
Practice Address - Country:US
Practice Address - Phone:616-942-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician