Provider Demographics
NPI:1528089109
Name:MELONAS, IRENE A (PHD)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:A
Last Name:MELONAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:120 S. MILL ST.
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-0146
Mailing Address - Country:US
Mailing Address - Phone:715-536-4440
Mailing Address - Fax:715-536-2736
Practice Address - Street 1:120 S MILL ST
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-2534
Practice Address - Country:US
Practice Address - Phone:715-536-4440
Practice Address - Fax:715-536-2736
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2136-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist