MEDICARE: MELANIE VIRGINIA WADE

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	CSW.09928603	CO

General Provider Information

NPI Number	:	1174240378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE VIRGINIA WADE

Provider Business Mailing Address
First Line	:	884 VINEYARD AVE
Second Line	:
City	:	PALISADE
State	:	CO
Zip	:	81526-6500
Country	:	US
Telephone Number	:	970-270-9647
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105B COLORADO AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-3522
Country	:	US
Telephone Number	:	970-242-4400
Fax Number	:

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

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	09/06/2024

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Directions to “ MELANIE VIRGINIA WADE ” Practice Location

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