Provider Demographics
NPI:1922248186
Name:WESTENDORF, MELISSA J (JD/PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:J
Last Name:WESTENDORF
Suffix:
Gender:F
Credentials:JD/PHD
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 511653
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-0281
Mailing Address - Country:US
Mailing Address - Phone:414-581-3236
Mailing Address - Fax:443-264-1279
Practice Address - Street 1:14135 N CEDARBURG RD STE 1
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-1416
Practice Address - Country:US
Practice Address - Phone:414-581-3236
Practice Address - Fax:443-264-1279
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2436-057103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical