MEDICARE: MRS. MELANIE SHIPMAN ED. S.

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	103TS0200X	School Psychologist	OH1343712	OH

General Provider Information

NPI Number	:	1598139545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANIE SHIPMAN ED. S.

Provider Business Mailing Address
First Line	:	8867 DURST COLEBROOK RD
Second Line	:
City	:	NORTH BLOOMFIELD
State	:	OH
Zip	:	44450-9529
Country	:	US
Telephone Number	:	330-505-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	8867 DURST COLEBROOK RD
Second Line	:
City	:	NORTH BLOOMFIELD
State	:	OH
Zip	:	44450-9529
Country	:	US
Telephone Number	:	330-505-2800
Fax Number	:

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

Provider Enumeration Date	:	11/13/2015
Last Update Date	:	11/13/2015

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