Provider Demographics
NPI:1770109225
Name:LINAM, MELADIE JOY
Entity type:Individual
Prefix:
First Name:MELADIE
Middle Name:JOY
Last Name:LINAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELADIE
Other - Middle Name:
Other - Last Name:BICKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5348 S 4300 W
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:UT
Mailing Address - Zip Code:84315-9523
Mailing Address - Country:US
Mailing Address - Phone:801-870-3003
Mailing Address - Fax:
Practice Address - Street 1:6910 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3060
Practice Address - Country:US
Practice Address - Phone:801-870-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-21
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician