Healthcare Provider Details

I. General information

NPI: 1538096177
Provider Name (Legal Business Name): LILLIAN MELLINGER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 NAVARRE CT
LAFAYETTE IN
47905-4348
US

IV. Provider business mailing address

3717 NAVARRE CT
LAFAYETTE IN
47905-4348
US

V. Phone/Fax

Practice location:
  • Phone: 765-430-7671
  • Fax:
Mailing address:
  • Phone: 765-430-7671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: