Provider Demographics
NPI:1912290511
Name:FOLK-JEDNOROZ, MELISSA JEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JEAN
Last Name:FOLK-JEDNOROZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7054
Mailing Address - Country:US
Mailing Address - Phone:815-271-5645
Mailing Address - Fax:815-271-5187
Practice Address - Street 1:715 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7054
Practice Address - Country:US
Practice Address - Phone:815-271-5645
Practice Address - Fax:815-271-5187
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
IL071.009064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid