1932300605 NPI number — MS. JEANNE LYN MELICK-SHIELD LISW, CADC

Table of content: MS. JEANNE LYN MELICK-SHIELD LISW, CADC (NPI 1932300605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932300605 NPI number — MS. JEANNE LYN MELICK-SHIELD LISW, CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELICK-SHIELD
Provider First Name:
JEANNE
Provider Middle Name:
LYN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LISW, CADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932300605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 WEST CHERRY STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LIBERTY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-626-3300
Provider Business Mailing Address Fax Number:
319-626-3084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 WEST CHERRY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LIBERTY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-626-3300
Provider Business Practice Location Address Fax Number:
319-626-3084
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  05859 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com