MEDICARE: MELISSA A GLOFF APSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	132312-121	WI

General Provider Information

NPI Number	:	1275247231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA A GLOFF APSW

Provider Business Mailing Address
First Line	:	530 WALNUT ST
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-3331
Country	:	US
Telephone Number	:	262-305-8075
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 WALNUT ST
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-3331
Country	:	US
Telephone Number	:	262-305-8075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2023
Last Update Date	:	01/12/2023

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