MEDICARE: BRIDGETTE MELTON PSS

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	175T00000X	Peer Specialist	6803087001	MI

General Provider Information

NPI Number	:	1215391479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETTE MELTON PSS

Provider Business Mailing Address
First Line	:	6425 SCHAEFER RD
Second Line	:	SUITE 2
City	:	DEARBORN
State	:	MI
Zip	:	48126-1974
Country	:	US
Telephone Number	:	313-846-2606
Fax Number	:

Provider Business Practice Location Address
First Line	:	6425 SCHAEFER RD
Second Line	:	SUITE 2
City	:	DEARBORN
State	:	MI
Zip	:	48126-1974
Country	:	US
Telephone Number	:	313-846-2606
Fax Number	:

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

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	07/18/2019

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