Provider Demographics
NPI:1932292984
Name:DINTELMAN, MELISSA ANN (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:DINTELMAN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 WEST POINTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902
Mailing Address - Country:US
Mailing Address - Phone:920-233-1800
Mailing Address - Fax:920-232-1538
Practice Address - Street 1:1820 WEST POINTE DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4164
Practice Address - Country:US
Practice Address - Phone:920-233-1800
Practice Address - Fax:920-232-1538
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI367-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41140200Medicaid
WIP25705Medicare UPIN
WIWI2786006Medicare PIN