MEDICARE: MRS. MELISSA CHILD

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	104100000X	Social Worker	LMSW-40310	ID

General Provider Information

NPI Number	:	1811585771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA CHILD

Provider Business Mailing Address
First Line	:	2184 CHANNING WAY # 248
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-8034
Country	:	US
Telephone Number	:	253-279-7924
Fax Number	:

Provider Business Practice Location Address
First Line	:	3765 US-20
Second Line	:
City	:	ISLAND PARK
State	:	ID
Zip	:	83429
Country	:	US
Telephone Number	:	208-549-9970
Fax Number	:

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

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	12/01/2023

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Directions to “ MRS. MELISSA CHILD ” Practice Location

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