Provider Demographics
NPI:1255488292
Name:HUGHES, MELINDA (MED)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N OLD WORLD 3RD ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1100
Mailing Address - Country:US
Mailing Address - Phone:414-224-0800
Mailing Address - Fax:
Practice Address - Street 1:1110 N OLD WORLD 3RD ST
Practice Address - Street 2:SUITE 401
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1100
Practice Address - Country:US
Practice Address - Phone:414-224-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12315101YA0400X
WI3008-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40916200Medicaid