=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588864458
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE ANN WALSH C.S.W.I.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2007
-----------------------------------------------------
Last Update Date | 07/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 S CENTER ST SUITE 500
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89501-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-337-4429
-----------------------------------------------------
Fax | 775-337-4565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11130
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89520-0027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-337-4429
-----------------------------------------------------
Fax | 775-337-4565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | IC-434
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------