Provider Demographics
NPI:1215011465
Name:MCNEILL, MELISSA A (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-4315
Mailing Address - Country:US
Mailing Address - Phone:815-543-2696
Mailing Address - Fax:
Practice Address - Street 1:64 ECLIPSE CTR
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3550
Practice Address - Country:US
Practice Address - Phone:608-363-6300
Practice Address - Fax:608-363-6392
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39677400Medicaid
WI084280013Medicare PIN