Provider Demographics
NPI:1073346540
Name:YOUNG, MELAINE
Entity type:Individual
Prefix:
First Name:MELAINE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-2608
Mailing Address - Country:US
Mailing Address - Phone:574-377-9049
Mailing Address - Fax:574-337-7193
Practice Address - Street 1:445 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-2608
Practice Address - Country:US
Practice Address - Phone:574-377-9049
Practice Address - Fax:574-337-7193
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300094907Medicaid