Provider Information for 1700614948
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
SUSAN LUCILLE MELLEMA LCSW
Sex: Female
NPI: 1700614948
Last Updated: 2024-07-22
Certification Date: 2024-07-21
Certification Date: 2024-07-21
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1700614948 | ||||||||
| Enumeration Date | 2024-07-22 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 711 HIDDEN CREEK LN NORTH AURORA, IL 60542-1165 United States Phone: 630-291-3005 | Fax: | ||||||||
| Primary Practice Address | 711 HIDDEN CREEK LN NORTH AURORA, IL 60542-1165 United States Phone: 630-291-3005 | Fax: | ||||||||
| Secondary Practice Address(es) | |||||||||
| Health Information Exchange |
| ||||||||
| Other Identifiers |
| ||||||||
| Taxonomy |
|