Provider Demographics
NPI:1245646363
Name:WEIPERT, MELISSA NICOLE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICOLE
Last Name:WEIPERT
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 1:9720 MONCLOVA RD
Mailing Address - Street 2:
Mailing Address - City:MONCLOVA
Mailing Address - State:OH
Mailing Address - Zip Code:43542-9432
Mailing Address - Country:US
Mailing Address - Phone:734-652-6007
Mailing Address - Fax:
Practice Address - Street 1:9720 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MONCLOVA
Practice Address - State:OH
Practice Address - Zip Code:43542-9432
Practice Address - Country:US
Practice Address - Phone:734-652-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011087571041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program