Healthcare Provider Details

I. General information

NPI: 1871411462
Provider Name (Legal Business Name): MELANIE GUZMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N SCHUYLER AVE STE 205
KANKAKEE IL
60901-3601
US

IV. Provider business mailing address

PO BOX 243
BOURBONNAIS IL
60914-0243
US

V. Phone/Fax

Practice location:
  • Phone: 815-348-4422
  • Fax:
Mailing address:
  • Phone: 815-278-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.025562
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: