MEDICARE: DR. MELISSA JEAN CHALMERS PSYD, LP

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	103TC0700X	Clinical Psychologist	LP6397	MN

General Provider Information

NPI Number	:	1245582055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA JEAN CHALMERS PSYD, LP

Provider Business Mailing Address
First Line	:	4225 TECHNOLOGY DR NW
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-5118
Country	:	US
Telephone Number	:	218-751-0282
Fax Number	:	218-751-0870

Provider Business Practice Location Address
First Line	:	4225 TECHNOLOGY DR NW
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-5118
Country	:	US
Telephone Number	:	218-214-1783
Fax Number	:

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

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	05/14/2019

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