Healthcare Provider Details

I. General information

NPI: 1447398417
Provider Name (Legal Business Name): MS. PATRICIA ANNE MELCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA ANNE SKARDA

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 UNIVERSITY AVE INTERIM HEALTH CARE SUITE #160
ST PAUL MN
55114
US

IV. Provider business mailing address

1366 WESTMINISTER STREET APT #105B
ST PAUL MN
55130-3344
US

V. Phone/Fax

Practice location:
  • Phone: 651-917-3634
  • Fax: 651-917-3620
Mailing address:
  • Phone: 651-771-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: