Healthcare Provider Details

I. General information

NPI: 1114401734
Provider Name (Legal Business Name): MELANIE KOHN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 W FILLMORE ST
CHICAGO IL
60624-4310
US

IV. Provider business mailing address

3605 W FILLMORE ST
CHICAGO IL
60624-4310
US

V. Phone/Fax

Practice location:
  • Phone: 773-588-0180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178013923
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: