Provider Demographics
NPI:1376439463
Name:MELNICK, LIESL PAULINE
Entity type:Individual
Prefix:
First Name:LIESL
Middle Name:PAULINE
Last Name:MELNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 SPECKLE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-4104
Mailing Address - Country:US
Mailing Address - Phone:224-205-0083
Mailing Address - Fax:
Practice Address - Street 1:350 SURRYSE RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3217
Practice Address - Country:US
Practice Address - Phone:847-842-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242008312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist