Individual
MELISSA BAGNALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
119 ICHORD AVE, WAYNESVILLE, MO 65583-5401
(901) 359-9017
Mailing address
118 SIERRA CIR APT A, WAYNESVILLE, MO 65583-6014
(901) 359-9017
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LSW0000005920
TN
Other
Enumeration date
09/11/2014
Last updated
10/30/2024
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