Provider Demographics
NPI:1932601614
Name:TERHAAR, MELINDA (LICSW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:TERHAAR
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 1:600 25TH AVE S
Mailing Address - Street 2:STE 109
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4820
Mailing Address - Country:US
Mailing Address - Phone:320-255-0343
Mailing Address - Fax:320-654-0313
Practice Address - Street 1:110 6TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-5209
Practice Address - Country:US
Practice Address - Phone:320-253-5930
Practice Address - Fax:651-925-0057
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN244261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical