MEDICARE: MELISSA DIANE YAEGER 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
1	101YP2500X	Professional Counselor	37PC006020700	NJ

General Provider Information

NPI Number	:	1508423195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA DIANE YAEGER LPC

Provider Business Mailing Address
First Line	:	603 BELL RD
Second Line	:
City	:	MOUNT EPHRAIM
State	:	NJ
Zip	:	08059-1714
Country	:	US
Telephone Number	:	856-651-8869
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 HIGHLAND AVE
Second Line	:
City	:	HADDON TWP
State	:	NJ
Zip	:	08108-2634
Country	:	US
Telephone Number	:	856-654-3155
Fax Number	:

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

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	05/20/2019

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