Provider Demographics
NPI:1861406381
Name:LAWSON, MELISSA ANN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:LAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 N VINE ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-1032
Mailing Address - Country:US
Mailing Address - Phone:317-430-2973
Mailing Address - Fax:
Practice Address - Street 1:308 MEDIC WAY
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2296
Practice Address - Country:US
Practice Address - Phone:765-653-2669
Practice Address - Fax:765-653-8671
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530AMedicaid
IN150074Medicare ID - Type Unspecified