Provider Demographics
NPI:1295720902
Name:POPP, MELANIE BELLEAU (CCC-A)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:BELLEAU
Last Name:POPP
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 EDEN AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2316
Mailing Address - Country:US
Mailing Address - Phone:952-929-2060
Mailing Address - Fax:952-929-2067
Practice Address - Street 1:5201 EDEN AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2316
Practice Address - Country:US
Practice Address - Phone:952-929-2060
Practice Address - Fax:952-929-2067
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7640174400000X
MN2540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500618000Medicaid
MN630175400Medicaid
MN640000268GRP03879Medicare PIN