MEDICARE: ALEXANDRIA MELTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801098385	MI

General Provider Information

NPI Number	:	1164875407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA MELTON

Provider Business Mailing Address
First Line	:	28 UNION AVE NE APT 3
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-5701
Country	:	US
Telephone Number	:	616-298-1965
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 UNION AVE NE APT 3
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-5701
Country	:	US
Telephone Number	:	616-298-1965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	07/21/2016

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Directions to “ ALEXANDRIA MELTON ” Practice Location

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