Healthcare Provider Details

I. General information

NPI: 1699856708
Provider Name (Legal Business Name): MELISSA JEAN NYTKO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA JEAN VAUGHAN

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 S MCLEAN BLVD
SOUTH ELGIN IL
60177-1859
US

IV. Provider business mailing address

1454 BLUME DR
ELGIN IL
60124-8719
US

V. Phone/Fax

Practice location:
  • Phone: 630-596-3688
  • Fax:
Mailing address:
  • Phone: 847-302-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149009678
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: