1336659580 NPI number — MS. MELINDA ERIN SPIKE LAC, COMT, CHC

Table of content: MS. MELINDA ERIN SPIKE LAC, COMT, CHC (NPI 1336659580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336659580 NPI number — MS. MELINDA ERIN SPIKE LAC, COMT, CHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPIKE
Provider First Name:
MELINDA
Provider Middle Name:
ERIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LAC, COMT, CHC
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:
1336659580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7275 147TH ST W STE 103B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLE VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55124-7809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-378-7894
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7275 147TH ST W STE 103B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55124-7809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-378-7894
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2017

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: 171100000X , with the licence number:  1812 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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