Individual
MELISSA ANN GALLUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
HWY 264 MPP 388, POLACCA, AZ 86042
(928) 737-6187
Mailing address
74 BUNNER ST, OSWEGO, NY 13126-3357
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
099082
NY
1041C0700X
Clinical Social Worker
Primary
4947
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497265953
—
NY
Enumeration date
10/10/2017
Last updated
10/21/2019
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