Healthcare Provider Details

I. General information

NPI: 1316140379
Provider Name (Legal Business Name): MELISSA KETNER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S MAIN ST STE 200
NAPERVILLE IL
60540-5485
US

IV. Provider business mailing address

50 S MAIN ST STE 200
NAPERVILLE IL
60540-5485
US

V. Phone/Fax

Practice location:
  • Phone: 800-525-9202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005637A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001762
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34506
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33005233A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: