Provider Demographics
NPI:1043567167
Name:WINTERFELDT, MELANIE LEE CICMIL (LGSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LEE CICMIL
Last Name:WINTERFELDT
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LEE
Other - Last Name:CICMIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:624 W. 13TH ST.
Mailing Address - Street 2:P.O. BOX 1188
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792
Mailing Address - Country:US
Mailing Address - Phone:218-749-2881
Mailing Address - Fax:218-749-3806
Practice Address - Street 1:3203 W. 3RD AVE.
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746
Practice Address - Country:US
Practice Address - Phone:218-263-9237
Practice Address - Fax:218-262-3150
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21684104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker