Provider Demographics
NPI:1558341198
Name:HUHN MELONE, CONNIE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:M
Last Name:HUHN MELONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1545
Mailing Address - Country:US
Mailing Address - Phone:920-765-0324
Mailing Address - Fax:920-361-2334
Practice Address - Street 1:141 W HURON ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1545
Practice Address - Country:US
Practice Address - Phone:920-765-0324
Practice Address - Fax:920-361-2334
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2024057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39120500Medicaid