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NPI Code Detail

MEDICARE: JESSICA MELLEN

MEDICARE: JESSICA MELLEN
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
11041C0700XClinical Social Worker6851120067MI

General Provider Information

NPI Number : 1730011370
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MELLEN
Provider Business Mailing Address
First Line : 8031 HERITAGE DR
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-9662
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4328 W MICHIGAN AVE
Second Line :
City : KALAMAZOO
State : MI
Zip : 49006-5823
Country : US
Telephone Number : 269-375-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2026
Last Update Date : 05/29/2026

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