Healthcare Provider Details

I. General information

NPI: 1205529377
Provider Name (Legal Business Name): MELADY VUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233A BUSINESS PARK DR STE 302
STEVENS POINT WI
54482-8861
US

IV. Provider business mailing address

261 PARADISE LN APT 3
PLOVER WI
54467-2073
US

V. Phone/Fax

Practice location:
  • Phone: 800-681-2374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number134262-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: