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NPI Code Detail

MEDICARE: DR. SUE A.W. MELCHER PSY.D.

MEDICARE: DR. SUE A.W. MELCHER PSY.D.
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
1103T00000XPsychologist2422-057WI

General Provider Information

NPI Number : 1609065929
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUE A.W. MELCHER PSY.D.
Provider Business Mailing Address
First Line : 2800 E ENTERPRISE AVE
Second Line : SUITE 1
City : APPLETON
State : WI
Zip : 54913-7889
Country : US
Telephone Number : 920-560-4503
Fax Number : 920-560-4501
Provider Business Practice Location Address
First Line : 2800 E ENTERPRISE AVE
Second Line : SUITE 1
City : APPLETON
State : WI
Zip : 54913-7889
Country : US
Telephone Number : 920-560-4503
Fax Number : 920-560-4501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2007
Last Update Date : 04/30/2010

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