Healthcare Provider Details

I. General information

NPI: 1801704556
Provider Name (Legal Business Name): STEPHANIE MELENDREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 W VLIET ST, MILWAUKEE, WI 53208
MILWAUKEE WI
53208
US

IV. Provider business mailing address

2813 S 47TH ST
MILWAUKEE WI
53219-3431
US

V. Phone/Fax

Practice location:
  • Phone: 414-475-8393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3001030686
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: