Provider Demographics
NPI:1053820118
Name:KEDDINGTON, MELISSA (MA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KEDDINGTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 E LINCOLN RD APT J365
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-7772
Mailing Address - Country:US
Mailing Address - Phone:801-318-7202
Mailing Address - Fax:
Practice Address - Street 1:1405 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3527
Practice Address - Country:US
Practice Address - Phone:509-218-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health