Provider Demographics
NPI:1386789097
Name:SWANK, MELINDA SUE (LCPC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:SWANK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 N CAMPBELL AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2951
Mailing Address - Country:US
Mailing Address - Phone:773-719-4272
Mailing Address - Fax:773-489-1434
Practice Address - Street 1:3166 N LINCOLN AVE
Practice Address - Street 2:SUITE 322
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3133
Practice Address - Country:US
Practice Address - Phone:773-719-4272
Practice Address - Fax:773-489-1434
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional