Healthcare Provider Details

I. General information

NPI: 1336095629
Provider Name (Legal Business Name): MELANIE KEIRNAN MSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 MANCHESTER RD STE 503-1
WHEATON IL
60187-4579
US

IV. Provider business mailing address

2100 MANCHESTER RD STE 503-1
WHEATON IL
60187-4579
US

V. Phone/Fax

Practice location:
  • Phone: 630-277-9447
  • Fax:
Mailing address:
  • Phone: 630-277-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2374901
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number150.129036
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: