Provider Demographics
NPI:1407369861
Name:MAKOVEC, MELISSA MARIE (BS, HIS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:MAKOVEC
Suffix:
Gender:F
Credentials:BS, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15425 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5156
Mailing Address - Country:US
Mailing Address - Phone:262-782-3400
Mailing Address - Fax:
Practice Address - Street 1:15425 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5156
Practice Address - Country:US
Practice Address - Phone:262-782-3400
Practice Address - Fax:262-782-3409
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1530-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1530-60OtherWISCONSIN HEARING INSTRUMENT SPECIALIST