Healthcare Provider Details

I. General information

NPI: 1265045843
Provider Name (Legal Business Name): MELISSA A PARTL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA SILBAUGH

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 N PALMER ST
MILWAUKEE WI
53212-3242
US

IV. Provider business mailing address

W175N11120 STONEWOOD DR
GERMANTOWN WI
53022-4799
US

V. Phone/Fax

Practice location:
  • Phone: 800-438-1772
  • Fax: 262-345-5562
Mailing address:
  • Phone: 800-438-1772
  • Fax: 262-345-5562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: