Provider Demographics
NPI:1124385125
Name:PERKINS, MELANIE KOLBE (LISW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:KOLBE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:KOLBE
Other - Last Name:WIEGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 S. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655
Mailing Address - Country:US
Mailing Address - Phone:319-850-2215
Mailing Address - Fax:
Practice Address - Street 1:400 S. BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655
Practice Address - Country:US
Practice Address - Phone:319-768-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL77731041C0700X
IA0078301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical