Provider Demographics
NPI:1912862806
Name:SNELLGROVE, MELISSA PIETSCH
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:PIETSCH
Last Name:SNELLGROVE
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 1:195 LAKEWOOD POINT DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2073
Mailing Address - Country:US
Mailing Address - Phone:318-465-3872
Mailing Address - Fax:
Practice Address - Street 1:195 LAKEWOOD POINT DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2073
Practice Address - Country:US
Practice Address - Phone:318-465-3872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-22
Last Update Date:2025-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208008163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health