MEDICARE: MS. MELINDA JANE ROUILLE MSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1720362486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELINDA JANE ROUILLE MSW

Provider Business Mailing Address
First Line	:	359 DORSET ST
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6210
Country	:	US
Telephone Number	:	910-489-6594
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 DORSET ST
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6210
Country	:	US
Telephone Number	:	910-489-6594
Fax Number	:

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

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	09/29/2011

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