Basic Information
| Provider Information | |||||||||
| NPI: | 1194972794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALDERDICE | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CGC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W LANCASTER AVE | ||||||||
| Address2: | STE 204 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761023410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828852170 | ||||||||
| FaxNumber: | 8173358277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 04/12/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | NA | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.