=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841185212
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE KLEBANOV MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5010 FAIRVIEW AVE STE 5
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60515-5201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-528-8855
-----------------------------------------------------
Fax | 630-541-6557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 OGDEN AVE # 112
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60515-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-528-8855
-----------------------------------------------------
Fax | 630-541-6557
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | PENDING
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------