Provider Demographics
NPI:1922255975
Name:SKLAR, MELISSA (LMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SKLAR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 GREEN CT
Mailing Address - Street 2:SUITE 185
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1566
Mailing Address - Country:US
Mailing Address - Phone:734-222-6046
Mailing Address - Fax:
Practice Address - Street 1:3520 GREEN CT
Practice Address - Street 2:SUITE 185
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1566
Practice Address - Country:US
Practice Address - Phone:734-222-6046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007978103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI593776870OtherTAX ID