Healthcare Provider Details

I. General information

NPI: 1316879190
Provider Name (Legal Business Name): MELINDA JAYNE TREVETHAN SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 W ROOSEVELT ST
CUBA CITY WI
53807-1220
US

IV. Provider business mailing address

212 S CLINTON ST
CUBA CITY WI
53807-1512
US

V. Phone/Fax

Practice location:
  • Phone: 608-744-2174
  • Fax:
Mailing address:
  • Phone: 608-732-7121
  • Fax: 608-690-5283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: