=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952014490
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA ELIZABETH SCHNEITER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2022
-----------------------------------------------------
Last Update Date | 02/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 414 BROADWAY ST STE 101
-----------------------------------------------------
City | BARABOO
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53913-2488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-566-7964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 BROADWAY ST STE 101
-----------------------------------------------------
City | BARABOO
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53913-2454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-566-7964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | 3321
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------