Provider Demographics
NPI:1639612872
Name:WILLAUER, MELISSA NOEL
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:NOEL
Last Name:WILLAUER
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 1:5 KING ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-9787
Mailing Address - Country:US
Mailing Address - Phone:484-368-2062
Mailing Address - Fax:
Practice Address - Street 1:5 KING ST
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-9787
Practice Address - Country:US
Practice Address - Phone:484-368-2062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002137106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician