Basic Information
| Provider Information | |||||||||
| NPI: | 1043514524 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELSON | ||||||||
| FirstName: | RAE | ||||||||
| MiddleName: | JONETTE | ||||||||
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| Credential: | M.S. ED. S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2349 RENAISSANCE DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891196191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027397716 | ||||||||
| FaxNumber: | 7025972242 | ||||||||
| Practice Location | |||||||||
| Address1: | 2349 RENAISSANCE DR | ||||||||
| Address2: | SUITE A. | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891196191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027397716 | ||||||||
| FaxNumber: | 7025972242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2010 | ||||||||
| LastUpdateDate: | 03/31/2011 | ||||||||
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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 | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 103TS0200X | 0000082665 | NV | Y | Behavioral Health & Social Service Providers | Psychologist | School |
No ID Information.