Provider Demographics
NPI:1770177586
Name:WESTFALL, MELISSA MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:WESTFALL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5398 KAHLER DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-9764
Mailing Address - Country:US
Mailing Address - Phone:330-430-9250
Mailing Address - Fax:
Practice Address - Street 1:5398 KAHLER DR NE
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-9764
Practice Address - Country:US
Practice Address - Phone:330-430-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00119751041C0700X
MN325821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEQ3-0000090OtherSTATE LICENSE
DEQ1-0011975OtherSTATE LICENSE