Provider Demographics
NPI:1689484255
Name:KOSTECKY, MELINDA (CT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:KOSTECKY
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 GARRISON RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4725
Mailing Address - Country:US
Mailing Address - Phone:419-345-9885
Mailing Address - Fax:
Practice Address - Street 1:1234 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2696
Practice Address - Country:US
Practice Address - Phone:419-408-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health