Basic Information
| Provider Information | |||||||||
| NPI: | 1437603875 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZISSLER | ||||||||
| FirstName: | MELONY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LBSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 LAPEER RD. | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48371 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 2489699932 | ||||||||
| FaxNumber: | 2489690840 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 S LAPEER RD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483716108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489699932 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2016 | ||||||||
| LastUpdateDate: | 08/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6802086172 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.