Provider Demographics
NPI:1376288811
Name:FELLER, MELISSA VIOLA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:VIOLA
Last Name:FELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13209 GIRARD CT
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2411
Mailing Address - Country:US
Mailing Address - Phone:952-230-0969
Mailing Address - Fax:
Practice Address - Street 1:13955 W PRESERVE BLVD STE 302
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-7733
Practice Address - Country:US
Practice Address - Phone:952-230-0969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN179291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical