Basic Information
| Provider Information | |||||||||
| NPI: | 1851588834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAULS | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | CRYSTAL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 94 N SANDUSKY ST | ||||||||
| Address2: | |||||||||
| City: | DELAWARE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430151775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403637234 | ||||||||
| FaxNumber: | 7403695931 | ||||||||
| Practice Location | |||||||||
| Address1: | 94 N SANDUSKY ST | ||||||||
| Address2: | |||||||||
| City: | DELAWARE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430151775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403637234 | ||||||||
| FaxNumber: | 7403695931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2007 | ||||||||
| LastUpdateDate: | 10/03/2007 | ||||||||
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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 | 1041C0700X | I 0500048 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1122BAS | 05 | OH | MEDICAID |