MEDICARE: MELISSA RAE WALDIE

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	6801092845	MI

General Provider Information

NPI Number	:	1356606628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA RAE WALDIE

Provider Business Mailing Address
First Line	:	1412 CENTER AVE
Second Line	:	APT A
City	:	BAY CITY
State	:	MI
Zip	:	48708-6174
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1106 WASHINGTON AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-5708
Country	:	US
Telephone Number	:	989-894-2991
Fax Number	:

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

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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Directions to “ MELISSA RAE WALDIE ” Practice Location

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