MEDICARE: MELISSA GIBB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	7401002830	MI

General Provider Information

NPI Number	:	1346134228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GIBB

Provider Business Mailing Address
First Line	:	510 FOREST AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-1958
Country	:	US
Telephone Number	:	313-909-2350
Fax Number	:	313-909-2350

Provider Business Practice Location Address
First Line	:	30701 BARRINGTON ST
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-5106
Country	:	US
Telephone Number	:	248-965-3916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	06/05/2025

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Directions to “ MELISSA GIBB ” Practice Location

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