Healthcare Provider Details

I. General information

NPI: 1093668303
Provider Name (Legal Business Name): MELISSA LUPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4365 LAWN AVE
WESTERN SPRINGS IL
60558-1465
US

IV. Provider business mailing address

4700 WOODLAND AVE
WESTERN SPRINGS IL
60558-1743
US

V. Phone/Fax

Practice location:
  • Phone: 773-888-2602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: