Provider Demographics
NPI:1689477572
Name:HETZEL, MELAINA
Entity type:Individual
Prefix:
First Name:MELAINA
Middle Name:
Last Name:HETZEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W FRANCISCAN DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4802
Mailing Address - Country:US
Mailing Address - Phone:888-419-2576
Mailing Address - Fax:888-419-2576
Practice Address - Street 1:205 W FRANCISCAN DR
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4802
Practice Address - Country:US
Practice Address - Phone:888-419-2576
Practice Address - Fax:888-419-2576
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician