Provider Demographics
NPI:1144589177
Name:VESELY, MELINDA (LCPC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:VESELY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:408 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2802
Mailing Address - Country:US
Mailing Address - Phone:815-690-3803
Mailing Address - Fax:815-324-5102
Practice Address - Street 1:408 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2802
Practice Address - Country:US
Practice Address - Phone:815-326-9502
Practice Address - Fax:815-324-5102
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional