Provider Demographics
NPI:1891353645
Name:ANDERSON, MELODY J (LSCSW)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 JOHNSON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2920
Mailing Address - Country:US
Mailing Address - Phone:913-533-7486
Mailing Address - Fax:913-533-7486
Practice Address - Street 1:5201 JOHNSON DR STE 400
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-2920
Practice Address - Country:US
Practice Address - Phone:913-533-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11102101YM0800X
KYLSCSW05340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health