Healthcare Provider Details

I. General information

NPI: 1053820118
Provider Name (Legal Business Name): MELISSA KEDDINGTON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 E 12TH AVE
SPOKANE WA
99202-3527
US

IV. Provider business mailing address

1718 E LINCOLN RD APT J365
SPOKANE WA
99217-7772
US

V. Phone/Fax

Practice location:
  • Phone: 509-218-0180
  • Fax:
Mailing address:
  • Phone: 801-318-7202
  • 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: