Provider Demographics
NPI:1174879613
Name:GEHRIG, MELISSA DAWN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:GEHRIG
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:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-2195
Mailing Address - Country:US
Mailing Address - Phone:570-296-1054
Mailing Address - Fax:570-296-9227
Practice Address - Street 1:10 BUIST RD STE 202
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9311
Practice Address - Country:US
Practice Address - Phone:570-296-1054
Practice Address - Fax:570-296-9227
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)