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NPI Code Detail

MEDICARE: MELINDA L JOHNSON LPC

MEDICARE: MELINDA L JOHNSON LPC
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
1101YP2500XProfessional Counselor4560-125WI

General Provider Information

NPI Number : 1205189545
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA L JOHNSON LPC
Provider Business Mailing Address
First Line : 15735 W US HIGHWAY 63
Second Line :
City : HAYWARD
State : WI
Zip : 54843-6475
Country : US
Telephone Number : 715-934-0710
Fax Number : 715-598-4881
Provider Business Practice Location Address
First Line : 15954 RIVERS EDGE DR
Second Line :
City : HAYWARD
State : WI
Zip : 54843-7800
Country : US
Telephone Number : 715-634-2541
Fax Number : 715-598-4881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2012
Last Update Date : 11/01/2023

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Directions to “ MELINDA L JOHNSON LPC” Practice Location

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