Healthcare Provider Details

I. General information

NPI: 1962923615
Provider Name (Legal Business Name): MELANIE ANN SHARPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E LINCOLN HWY STE A
DEKALB IL
60115-3990
US

IV. Provider business mailing address

1500 E LINCOLN HWY STE A
DEKALB IL
60115-3990
US

V. Phone/Fax

Practice location:
  • Phone: 779-201-8006
  • Fax: 779-256-0204
Mailing address:
  • Phone: 779-201-8006
  • Fax: 779-256-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178012910
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: