=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659184224
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEENA MELONE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2025
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N91W17194 APPLETON AVE
-----------------------------------------------------
City | MENOMONEE FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53051-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-502-7780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4524 N WILSON DR APT 3
-----------------------------------------------------
City | SHOREWOOD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53211-1344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-790-9656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 8293226
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------