Healthcare Provider Details

I. General information

NPI: 1588139844
Provider Name (Legal Business Name): MELODY LINNEAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 12/01/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 HARVEY AVE
BERWYN IL
60402-1411
US

IV. Provider business mailing address

1534 HARVEY AVE
BERWYN IL
60402-1411
US

V. Phone/Fax

Practice location:
  • Phone: 630-230-7113
  • Fax: 630-929-7570
Mailing address:
  • Phone: 630-788-4585
  • Fax: 630-929-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.012752
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: