Healthcare Provider Details

I. General information

NPI: 1043606478
Provider Name (Legal Business Name): MELISSA HECKNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13717 S ROUTE 30
PLAINFIELD IL
60544
US

IV. Provider business mailing address

13717 S ROUTE 30 STE 159
PLAINFIELD IL
60544-5561
US

V. Phone/Fax

Practice location:
  • Phone: 877-443-7030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: