Provider Demographics
NPI:1720829070
Name:DEWEESE, MELINA ANN (RBT)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:ANN
Last Name:DEWEESE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8841 E STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-9542
Mailing Address - Country:US
Mailing Address - Phone:843-609-7280
Mailing Address - Fax:
Practice Address - Street 1:4070 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3161
Practice Address - Country:US
Practice Address - Phone:843-609-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-17-37422106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician