Individual
KAITLYN MELLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5534 MEDICAL CIR, MADISON, WI 53719-1202
(608) 274-0355
Mailing address
5534 MEDICAL CIR, MADISON, WI 53719-1202
(608) 212-6965
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10170-123
WI
Other
Enumeration date
07/18/2023
Last updated
07/18/2023
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