MEDICARE: MELISSA MARY MACNEAL PH.D.

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	103K00000X	Behavior Analyst	CL60303302	WA

General Provider Information

NPI Number	:	1235573338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MARY MACNEAL PH.D.

Provider Business Mailing Address
First Line	:	2615 OLD HIGHWAY 99 S RD
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-9029
Country	:	US
Telephone Number	:	360-691-9824
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 OLD HIGHWAY 99 S RD
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-9029
Country	:	US
Telephone Number	:	360-691-9824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2013
Last Update Date	:	04/19/2013

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