Provider Demographics
NPI:1902464688
Name:KLASS, MELISSA A (CADC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:KLASS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:POTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5759
Mailing Address - Country:US
Mailing Address - Phone:800-482-8305
Mailing Address - Fax:
Practice Address - Street 1:720 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5759
Practice Address - Country:US
Practice Address - Phone:800-482-8305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA10017101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)