Provider Demographics
NPI:1285102756
Name:SUMROW, MELISSA (MSW, QMHP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:SUMROW
Suffix:
Gender:F
Credentials:MSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16713 W APACHE DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-4282
Mailing Address - Country:US
Mailing Address - Phone:630-631-9062
Mailing Address - Fax:
Practice Address - Street 1:58 E CLINTON ST STE 200
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-4193
Practice Address - Country:US
Practice Address - Phone:815-723-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker