MEDICARE: MRS. MELISSA DIONE FRODGE LCSW

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	LMSW-11669	AZ
2	1041C0700X	Clinical Social Worker	LCSW-12123	AZ

General Provider Information

NPI Number	:	1881672277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA DIONE FRODGE LCSW

Provider Business Mailing Address
First Line	:	4860 S CHAMPLAIN PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85730-4644
Country	:	US
Telephone Number	:	520-429-6587
Fax Number	:

Provider Business Practice Location Address
First Line	:	5380 E KACHINA ST
Second Line	:	BLDG. 4220
City	:	TUCSON
State	:	AZ
Zip	:	85707-4923
Country	:	US
Telephone Number	:	520-228-2104
Fax Number	:

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	10/06/2008

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