Provider Demographics
NPI:1750574109
Name:O'LEARY, MELINDA (LISW)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 3RD ST SE
Mailing Address - Street 2:SUITE 514
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1514
Mailing Address - Country:US
Mailing Address - Phone:319-360-5041
Mailing Address - Fax:
Practice Address - Street 1:222 3RD ST SE
Practice Address - Street 2:SUITE 514
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1514
Practice Address - Country:US
Practice Address - Phone:319-360-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA032191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1750574109OtherPENDING