Provider Demographics
NPI:1376032862
Name:PERRIN, MELANIE (MA,ICS, CSAC, SAP,)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PERRIN
Suffix:
Gender:F
Credentials:MA,ICS, CSAC, SAP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2380
Mailing Address - Country:US
Mailing Address - Phone:715-629-2080
Mailing Address - Fax:715-629-2090
Practice Address - Street 1:216 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2380
Practice Address - Country:US
Practice Address - Phone:715-629-2080
Practice Address - Fax:715-629-2090
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI825362059101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)