Healthcare Provider Details

I. General information

NPI: 1013298983
Provider Name (Legal Business Name): MELINDA SUE BURCHFIELD MSW,LCSW, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HAZEL ST
CARTHAGE MO
64836-2850
US

IV. Provider business mailing address

17472 BUSINESS 60
NEOSHO MO
64850-8577
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-0188
  • Fax: 417-358-0189
Mailing address:
  • Phone: 417-451-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011028758
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number10421039
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: