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General NPI Number Information
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NPI Number | 1144589177
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Entity Type | Individual
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Provider Name | MELINDA VESELY LCPC
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Gender | Female
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 408 W MAIN ST
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City | OTTAWA
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State | IL
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Zip | 61350-2802
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Country | US
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Telephone | 815-326-9502
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Fax | 815-324-5102
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Provider Business Mailing Address
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Address Line | 408 W MAIN ST
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City | OTTAWA
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State | IL
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Zip | 61350-2802
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Country | US
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Telephone | 815-690-3803
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Fax | 815-324-5102
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180009272
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License Number State | IL
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