Individual
MELISSA A WINGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-7815
(262) 948-7816
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 385-8771
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
3474
WI
103TC0700X
Clinical Psychologist
3474
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100070524
—
WI
Enumeration date
06/07/2017
Last updated
11/24/2023
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