Provider Demographics
NPI:1841688124
Name:GARDNER, MELANIE JANE (LMSW)
Entity type:Individual
Prefix:MISS
First Name:MELANIE
Middle Name:JANE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 EMMETT ST W
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-2963
Mailing Address - Country:US
Mailing Address - Phone:269-965-8866
Mailing Address - Fax:269-966-2627
Practice Address - Street 1:181 EMMETT ST W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-2963
Practice Address - Country:US
Practice Address - Phone:269-965-8866
Practice Address - Fax:269-966-2627
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010971611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical