Individual
MELISSA LYNN GANDEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22394 LAKE PARK BLVD, ALLIANCE, OH 44601-3467
(330) 596-0710
Mailing address
22394 LAKE PARK BLVD, ALLIANCE, OH 44601-3467
(330) 596-0710
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
5005964
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5005964
DODD
OH
05
—
5005964
—
OH
Enumeration date
09/10/2020
Last updated
09/10/2020
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