Healthcare Provider Details

I. General information

NPI: 1487561551
Provider Name (Legal Business Name): EMMA MELOTIK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 W VLIET ST
MILWAUKEE WI
53208-2627
US

IV. Provider business mailing address

1035 PINEHURST CT APT 103
BROOKFIELD WI
53005-7076
US

V. Phone/Fax

Practice location:
  • Phone: 262-470-8896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: