MEDICARE: MELAINIE TUGGLE MSW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1083490726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELAINIE TUGGLE MSW, LLC

Provider Business Mailing Address
First Line	:	14135 N CEDARBURG RD # 203
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53097-1416
Country	:	US
Telephone Number	:	262-377-2006
Fax Number	:	262-377-5552

Provider Business Practice Location Address
First Line	:	2730 N AVONDALE BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1361
Country	:	US
Telephone Number	:	414-263-9355
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MELAINIE R TUGGLE
Credential	:	MSW, LCSW
Telephone Number	:	414-263-9355

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/27/2023

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