Healthcare Provider Details

I. General information

NPI: 1306758701
Provider Name (Legal Business Name): MELAINA G MENDOZA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 ORCHARD AVE
SAINT JOSEPH MI
49085-2114
US

IV. Provider business mailing address

1003 CARLEY LN
SAINT JOSEPH MI
49085-3505
US

V. Phone/Fax

Practice location:
  • Phone: 269-926-3700
  • Fax:
Mailing address:
  • Phone: 269-313-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801114526
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: