Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 2011028758 | MO |
N | 174N00000X | Lactation Consultant | 10421039 | MO |
NPI | 1013298983 |
---|---|
Provider Name | Mrs. Melinda Sue Burchfield |
First Address | Neosho, MO 64850-8577 |
Second Address | Carthage, MO 64836-2850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2011 |
Last Update Date | 01/11/2011 |