Individual
MISS MELISSA DANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
904 E MARTIN LUTHER KING DR., CENTRALIA, IL 62801
(618) 533-1391
(618) 533-1200
Mailing address
PO BOX 231, IRVINGTON, IL 62848-0231
(618) 533-1391
(618) 533-1200
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370915481007
—
IL
Enumeration date
10/15/2014
Last updated
10/15/2014
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