Provider Demographics
NPI:1275026866
Name:HARDGE, MELINDA A (LPC-IT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:A
Last Name:HARDGE
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 N 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1705
Mailing Address - Country:US
Mailing Address - Phone:414-445-9180
Mailing Address - Fax:414-445-5995
Practice Address - Street 1:4065 N 35TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1705
Practice Address - Country:US
Practice Address - Phone:414-445-9180
Practice Address - Fax:414-445-5995
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI626693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health