Healthcare Provider Details

I. General information

NPI: 1891320198
Provider Name (Legal Business Name): MRS. MELANIE FUREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36100 GENESEE LAKE RD
OCONOMOWOC WI
53066-9201
US

IV. Provider business mailing address

3826 PLEASANT VALLEY RD
WEST BEND WI
53095-9272
US

V. Phone/Fax

Practice location:
  • Phone: 262-569-5510
  • Fax:
Mailing address:
  • Phone: 847-373-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5319154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: