Provider Demographics
NPI:1720326341
Name:MELANIE EDLIN
Entity Type:Organization
Organization Name:MELANIE EDLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL INTERVENTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:EDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-763-9404
Mailing Address - Street 1:395 YOUNGERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7788
Mailing Address - Country:US
Mailing Address - Phone:207-763-9404
Mailing Address - Fax:
Practice Address - Street 1:395 YOUNGERS CREEK RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7788
Practice Address - Country:US
Practice Address - Phone:207-763-9404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200402743222Q00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty