Provider Demographics
NPI:1750702791
Name:HETZEL-RIGGIN, MELANIE (PHD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:HETZEL-RIGGIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:HETZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5501 GARDNER DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3020
Mailing Address - Country:US
Mailing Address - Phone:309-335-6215
Mailing Address - Fax:
Practice Address - Street 1:5501 GARDNER DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-3020
Practice Address - Country:US
Practice Address - Phone:309-335-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007382103TC0700X
PATPS030199103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical