Provider Demographics
NPI:1154190262
Name:TESCH, MELODY RAE
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:RAE
Last Name:TESCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:RAE
Other - Last Name:DEVRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 19TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-2823
Mailing Address - Country:US
Mailing Address - Phone:605-886-0123
Mailing Address - Fax:605-886-5447
Practice Address - Street 1:123 19TH ST NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-2823
Practice Address - Country:US
Practice Address - Phone:605-886-0123
Practice Address - Fax:605-886-5447
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)