MEDICARE: ELLEN MELOY

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1285911990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN MELOY

Provider Business Mailing Address
First Line	:	3343 N LEAVITT ST APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6242
Country	:	US
Telephone Number	:	507-254-1151
Fax Number	:

Provider Business Practice Location Address
First Line	:	3343 N LEAVITT ST APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6242
Country	:	US
Telephone Number	:	507-254-1151
Fax Number	:

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

Provider Enumeration Date	:	11/09/2011
Last Update Date	:	11/09/2011

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Directions to “ ELLEN MELOY ” Practice Location

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