Provider Demographics
NPI:1982780201
Name:HEMPHILL, MELINDA M (CNW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:M
Last Name:HEMPHILL
Suffix:
Gender:F
Credentials:CNW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-1416
Mailing Address - Country:US
Mailing Address - Phone:541-573-2271
Mailing Address - Fax:541-573-8388
Practice Address - Street 1:420 N FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1416
Practice Address - Country:US
Practice Address - Phone:541-573-2271
Practice Address - Fax:541-573-8388
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59431893502101YP2500X
ORL70221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
260022408OtherRAIL ROAD MEDICARE