| NPI | 1043814684 |
|---|---|
| Former Name | KELLY LYNN MELDE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302363) |
| Enumeration Date | 2020-11-24 |
| Last Update Date | 2020-11-24 |