Provider Demographics
NPI:1346058104
Name:ANDERSON, MELODY E (QMHS)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 CHERRY WOOD LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1209
Mailing Address - Country:US
Mailing Address - Phone:419-360-9712
Mailing Address - Fax:
Practice Address - Street 1:5461 SOUTHWYCK BLVD STE 2L
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1553
Practice Address - Country:US
Practice Address - Phone:419-913-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator