Provider Demographics
NPI:1194076497
Name:BOYER, MELODY DAWN (LICSW)
Entity type:Individual
Prefix:MS
First Name:MELODY
Middle Name:DAWN
Last Name:BOYER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:MELODY
Other - Middle Name:DAWN
Other - Last Name:ROHWEDDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:HOHENFELS HEALTH CLINIC
Mailing Address - Street 2:CMR 414 BOX 25216
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09173
Mailing Address - Country:US
Mailing Address - Phone:314-590-3346
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1634104100000X
NE15901041C0700X
NELIMHP1590MSW1634104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical