Provider Demographics
NPI:1386139384
Name:WALKOWSKI, MELISSA JO (LCSW, SAC-IT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JO
Last Name:WALKOWSKI
Suffix:
Gender:F
Credentials:LCSW, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25986 E. MONDOVI ST.
Mailing Address - Street 2:P.O. BOX 231
Mailing Address - City:ELEVA
Mailing Address - State:WI
Mailing Address - Zip Code:54738
Mailing Address - Country:US
Mailing Address - Phone:715-523-1283
Mailing Address - Fax:
Practice Address - Street 1:550 N DEWEY ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-3218
Practice Address - Country:US
Practice Address - Phone:715-834-6681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8698-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical