Healthcare Provider Details

I. General information

NPI: 1447199500
Provider Name (Legal Business Name): MRS. MELEAH HOPE MACNEILLE-PEDERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. VALRAVN MACNEILLE-PEDERSEN

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 S LINCOLN AVE
SPRINGFIELD IL
62704-1607
US

IV. Provider business mailing address

537 S LINCOLN AVE
SPRINGFIELD IL
62704-1607
US

V. Phone/Fax

Practice location:
  • Phone: 480-512-1335
  • Fax:
Mailing address:
  • Phone: 480-512-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-440152
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: