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NPI Code Detail

MEDICARE: MELODY LYNN GORDEN MSW LICSW

MEDICARE: MELODY LYNN GORDEN MSW LICSW
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
11041C0700XClinical Social Worker23305MN

General Provider Information

NPI Number : 1750888475
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELODY LYNN GORDEN MSW LICSW
Provider Business Mailing Address
First Line : 1217 ANNE ST NW
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-5113
Country : US
Telephone Number : 218-755-6360
Fax Number : 218-755-6399
Provider Business Practice Location Address
First Line : 112 1ST ST W
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-4002
Country : US
Telephone Number : 218-888-8032
Fax Number : 218-888-8033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2018
Last Update Date : 12/17/2025

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