Provider Demographics
NPI:1336987429
Name:LUMPKIN, MELODY R
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:R
Last Name:LUMPKIN
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 1:3080 MCHENRY AVE APT 33
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-7366
Mailing Address - Country:US
Mailing Address - Phone:513-675-5369
Mailing Address - Fax:
Practice Address - Street 1:3080 MCHENRY AVE APT 33
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-7366
Practice Address - Country:US
Practice Address - Phone:513-675-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH591550159ML251C00000X
OH5915550159251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services