1215051834 NPI number — MELINDA L BRYAN M.A.

Table of content: MELINDA L BRYAN M.A. (NPI 1215051834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215051834 NPI number — MELINDA L BRYAN M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYAN
Provider First Name:
MELINDA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215051834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
516 HIGH ST
Provider Second Line Business Mailing Address:
MS9171
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-650-3881
Provider Business Mailing Address Fax Number:
360-650-4334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 HIGH ST
Provider Second Line Business Practice Location Address:
MS9171
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-650-3881
Provider Business Practice Location Address Fax Number:
360-650-4334
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  LD00000971 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: LD00000971 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 99220 . This is a "HEARPO" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 108285 . This is a "L&I NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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