Provider Demographics
NPI:1457072563
Name:VAUSE, MELANIE KAY
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:KAY
Last Name:VAUSE
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 1:1645 BIRMINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-1914
Mailing Address - Country:US
Mailing Address - Phone:815-307-0848
Mailing Address - Fax:
Practice Address - Street 1:10 GUEST ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2066
Practice Address - Country:US
Practice Address - Phone:781-647-9976
Practice Address - Fax:781-647-9956
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical