Provider Demographics
NPI:1609065929
Name:MELCHER, SUE AW (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:AW
Last Name:MELCHER
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 1:2800 E ENTERPRISE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7889
Mailing Address - Country:US
Mailing Address - Phone:920-560-4503
Mailing Address - Fax:920-560-4501
Practice Address - Street 1:2800 E ENTERPRISE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7889
Practice Address - Country:US
Practice Address - Phone:920-560-4503
Practice Address - Fax:920-560-4501
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2422-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist