Healthcare Provider Details

I. General information

NPI: 1467360438
Provider Name (Legal Business Name): MELINDA PADLO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20700 CIVIC CENTER DR STE 110
SOUTHFIELD MI
48076-4102
US

IV. Provider business mailing address

22862 OAKLANE ST
WARREN MI
48089-5452
US

V. Phone/Fax

Practice location:
  • Phone: 800-385-1035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: