Provider Demographics
NPI:1306067848
Name:WENSZELL SAMBORKSI, MELISSA JANE (MT-BC, NMT)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JANE
Last Name:WENSZELL SAMBORKSI
Suffix:
Gender:F
Credentials:MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6428 WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1515
Mailing Address - Country:US
Mailing Address - Phone:612-281-0307
Mailing Address - Fax:
Practice Address - Street 1:501 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-2383
Practice Address - Country:US
Practice Address - Phone:612-321-0100
Practice Address - Fax:612-767-5556
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225A00000X225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN113742OtherUCARE OF MINNESOTA