Healthcare Provider Details

I. General information

NPI: 1750888475
Provider Name (Legal Business Name): MELODY LYNN GORDEN MSW LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 1ST ST W
BEMIDJI MN
56601-4002
US

IV. Provider business mailing address

1217 ANNE ST NW
BEMIDJI MN
56601-5113
US

V. Phone/Fax

Practice location:
  • Phone: 218-888-8032
  • Fax: 218-888-8033
Mailing address:
  • Phone: 218-755-6360
  • Fax: 218-755-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23305
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: