Provider Demographics
NPI:1427122100
Name:MELSON, STEPHEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:MELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:J
Other - Last Name:MELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:901 BOREN AVE
Mailing Address - Street 2:STE 1020
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3595
Mailing Address - Country:US
Mailing Address - Phone:206-624-6454
Mailing Address - Fax:206-624-1489
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:SUITE 1020
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3508
Practice Address - Country:US
Practice Address - Phone:206-624-6454
Practice Address - Fax:206-624-1489
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014189103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0614140OtherLABOR & INDUSTRY ID #
WA1116748Medicaid
WAAM6289044OtherDEA #
WA1116748Medicaid
WAAM6289044OtherDEA #