Healthcare Provider Details

I. General information

NPI: 1407057581
Provider Name (Legal Business Name): MELANIE AMIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TOWER CT STE 300
GURNEE IL
60031-3346
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-599-3600
  • Fax: 847-599-8897
Mailing address:
  • Phone: 847-982-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149008147
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: