Provider Demographics
NPI:1285118364
Name:MELQUIST, JEANENE LYNN
Entity type:Individual
Prefix:
First Name:JEANENE
Middle Name:LYNN
Last Name:MELQUIST
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 1:1351 S REYNOLDS RD STE B
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7411
Mailing Address - Country:US
Mailing Address - Phone:419-461-9334
Mailing Address - Fax:
Practice Address - Street 1:1351 S REYNOLDS RD STE B
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7411
Practice Address - Country:US
Practice Address - Phone:419-461-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2203030101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional