Healthcare Provider Details

I. General information

NPI: 1821228362
Provider Name (Legal Business Name): MELINDA DWORKIN & ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 SHERMAN AVE SUITE 300
EVANSTON IL
60201-3753
US

IV. Provider business mailing address

1617 BRUMMEL ST
EVANSTON IL
60202-3709
US

V. Phone/Fax

Practice location:
  • Phone: 847-475-0451
  • Fax: 847-475-4849
Mailing address:
  • Phone: 847-475-0451
  • Fax: 847-475-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.011855
License Number StateIL

VIII. Authorized Official

Name: MS. MELINDA DWORKIN
Title or Position: PRESIDENT
Credential: LCSW
Phone: 847-475-0451