Individual
MELINDA ANNETTE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22 MEADOWBROOK AVE, BOARDMAN, OH 44512-2605
(330) 774-4670
Mailing address
22 MEADOWBROOK AVE, BOARDMAN, OH 44512-2605
(330) 774-4670
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5505995
—
OH
Enumeration date
10/15/2020
Last updated
10/15/2020
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