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General NPI Number Information
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NPI Number | 1093149452
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Entity Type | Individual
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Provider Name | MELISSA BUCKLEY
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Gender | Female
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 325 IL ROUTE 2
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City | DIXON
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State | IL
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Zip | 61021-9118
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Country | US
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Telephone | 815-284-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 311 W PARK ST
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City | MORRISON
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State | IL
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Zip | 61270-2319
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Country | US
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Telephone | 815-213-4389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 149.024911
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 149.024911
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License Number State | IL
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