Provider Demographics
NPI:1073755609
Name:MAERZ, MELODIE H (AUD)
Entity Type:Individual
Prefix:DR
First Name:MELODIE
Middle Name:H
Last Name:MAERZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 WESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-0807
Mailing Address - Country:US
Mailing Address - Phone:319-520-7751
Mailing Address - Fax:
Practice Address - Street 1:393 DUNLAP ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4200
Practice Address - Country:US
Practice Address - Phone:651-646-2427
Practice Address - Fax:651-649-3018
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000717231H00000X
MO2009021155231H00000X
IL147.001373231H00000X
IA000980237700000X
MN8444231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist