Healthcare Provider Details

I. General information

NPI: 1073120010
Provider Name (Legal Business Name): MELISSA RENEE SHIKANY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST FL 14
CHICAGO IL
60611-5975
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 14-200
CHICAGO IL
60611-5966
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-8347
  • Fax:
Mailing address:
  • Phone: 312-695-7382
  • Fax: 312-695-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.017196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: