Provider Demographics
NPI:1679004964
Name:SEIDEL, MELISSA (LGSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1401
Mailing Address - Country:US
Mailing Address - Phone:763-762-6806
Mailing Address - Fax:763-315-4669
Practice Address - Street 1:2001 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1401
Practice Address - Country:US
Practice Address - Phone:763-762-6806
Practice Address - Fax:763-315-4669
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22358104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker