Healthcare Provider Details

I. General information

NPI: 1184417206
Provider Name (Legal Business Name): MELISSA L CONRAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9845 W ROOSEVELT RD FL 2
WESTCHESTER IL
60154-2758
US

IV. Provider business mailing address

2825 GABRIELLA ST UNIT 403
DOWNERS GROVE IL
60515-3988
US

V. Phone/Fax

Practice location:
  • Phone: 708-786-2057
  • Fax:
Mailing address:
  • Phone: 847-962-9446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.031600
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: