Provider Demographics
NPI:1750888475
Name:GORDEN, MELODY LYNN (MSW LICSW)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:LYNN
Last Name:GORDEN
Suffix:
Gender:
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 9TH AVE W
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2204
Mailing Address - Country:US
Mailing Address - Phone:320-763-3466
Mailing Address - Fax:320-763-3227
Practice Address - Street 1:620 9TH AVE W
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2204
Practice Address - Country:US
Practice Address - Phone:320-763-3466
Practice Address - Fax:320-763-3227
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN233051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical