Healthcare Provider Details

I. General information

NPI: 1922344530
Provider Name (Legal Business Name): MELINDA ALSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2012
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S BLANCHARD ST
WHEATON IL
60187-5813
US

IV. Provider business mailing address

109 S BLANCHARD ST
WHEATON IL
60187-5813
US

V. Phone/Fax

Practice location:
  • Phone: 630-205-8294
  • Fax:
Mailing address:
  • Phone: 630-205-8294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2082711
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149005201
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: