Provider Demographics
NPI:1083490726
Name:MELAINIE TUGGLE MSW, LLC
Entity Type:Organization
Organization Name:MELAINIE TUGGLE MSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MELAINIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUGGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:414-263-9355
Mailing Address - Street 1:14135 N CEDARBURG RD # 203
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-1416
Mailing Address - Country:US
Mailing Address - Phone:262-377-2006
Mailing Address - Fax:262-377-5552
Practice Address - Street 1:2730 N AVONDALE BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1361
Practice Address - Country:US
Practice Address - Phone:414-263-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty