Healthcare Provider Details

I. General information

NPI: 1922710979
Provider Name (Legal Business Name): SOLEDAD MARIA MELGAR LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 N COUNTY ST
WAUKEGAN IL
60085-4315
US

IV. Provider business mailing address

6149 S KENNETH AVE
CHICAGO IL
60629-5209
US

V. Phone/Fax

Practice location:
  • Phone: 773-581-4357
  • Fax: 773-498-7186
Mailing address:
  • Phone: 773-581-4357
  • Fax: 773-498-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150106682
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: