Healthcare Provider Details

I. General information

NPI: 1164735544
Provider Name (Legal Business Name): MELEIKA A WADLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21253 N 36TH PL PHOENIX AZ
PHOENIX AZ
85050-8388
US

IV. Provider business mailing address

21253 N 36TH PL PHOENIX AZ
PHOENIX AZ
85050-8388
US

V. Phone/Fax

Practice location:
  • Phone: 216-659-8109
  • Fax:
Mailing address:
  • Phone: 216-659-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI. 1200891
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLCSW-15306
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: