MEDICARE: NADINE MELESKI CADC III, RCS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	11085	WI

General Provider Information

NPI Number	:	1750302956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE MELESKI CADC III, RCS

Provider Business Mailing Address
First Line	:	285 N JANACEK RD
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-6102
Country	:	US
Telephone Number	:	262-641-9050
Fax Number	:	262-641-9126

Provider Business Practice Location Address
First Line	:	5678 W BROWN DEER RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-2365
Country	:	US
Telephone Number	:	414-362-8147
Fax Number	:	414-362-7198

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	07/08/2007

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