Healthcare Provider Details

I. General information

NPI: 1518478296
Provider Name (Legal Business Name): MELISSA BUENIK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date: 06/30/2021
Reactivation Date: 02/23/2023

III. Provider practice location address

1350 W HAWLEY ST
MUNDELEIN IL
60060-1504
US

IV. Provider business mailing address

1350 W HAWLEY ST
MUNDELEIN IL
60060-1504
US

V. Phone/Fax

Practice location:
  • Phone: 847-949-2200
  • Fax:
Mailing address:
  • Phone: 847-949-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.019504
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: