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General NPI Number Information
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NPI Number | 1699062604
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Entity Type | Individual
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Provider Name | MELODY WOLLGREN LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 95 ALLENS CREEK RD BLDG 2, STE 325
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City | ROCHESTER
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State | NY
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Zip | 14618
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Country | US
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Telephone | 585-999-5145
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Fax |
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Provider Business Mailing Address
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Address Line | 44 HARWOOD CIR
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City | ROCHESTER
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State | NY
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Zip | 14625-1610
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Country | US
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Telephone | 607-742-3829
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1149
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License Number State | CO
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