Provider Demographics
NPI:1043514524
Name:MELSON, RAE JONETTE (MS ED S)
Entity type:Individual
Prefix:
First Name:RAE
Middle Name:JONETTE
Last Name:MELSON
Suffix:
Gender:F
Credentials:MS ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 RENAISSANCE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6191
Mailing Address - Country:US
Mailing Address - Phone:702-739-7716
Mailing Address - Fax:702-597-2242
Practice Address - Street 1:2349 RENAISSANCE DR
Practice Address - Street 2:SUITE A.
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6191
Practice Address - Country:US
Practice Address - Phone:702-739-7716
Practice Address - Fax:702-597-2242
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NV0000082665103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner