Healthcare Provider Details

I. General information

NPI: 1073270989
Provider Name (Legal Business Name): MELISSA LENIECE OLIVER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA L OLIVER LCSW

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 S STATE ST
CHICAGO IL
60609-3701
US

IV. Provider business mailing address

PO BOX 746715
ATLANTA GA
30374-6715
US

V. Phone/Fax

Practice location:
  • Phone: 773-285-9304
  • Fax:
Mailing address:
  • Phone: 773-352-1515
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149022595
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: