Provider Demographics
NPI:1558632026
Name:ZIEBART, MELANIE A (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:ZIEBART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-0101
Mailing Address - Country:US
Mailing Address - Phone:618-795-2697
Mailing Address - Fax:618-731-4178
Practice Address - Street 1:40B EDWARDSVILLE PROF PARK # 62025
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3602
Practice Address - Country:US
Practice Address - Phone:618-795-2697
Practice Address - Fax:618-731-4178
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490137541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical