Provider Demographics
NPI:1932300605
Name:MELICK-SHIELD, JEANNE LYN (LISW, CADC)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:LYN
Last Name:MELICK-SHIELD
Suffix:
Gender:F
Credentials:LISW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WEST CHERRY STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317
Mailing Address - Country:US
Mailing Address - Phone:319-626-3300
Mailing Address - Fax:319-626-3084
Practice Address - Street 1:320 WEST CHERRY STREET
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317
Practice Address - Country:US
Practice Address - Phone:319-626-3300
Practice Address - Fax:319-626-3084
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA058591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical