MEDICARE: MELISA GONZALEZ LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	150.116857	IL

General Provider Information

NPI Number	:	1174480479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISA GONZALEZ LSW

Provider Business Mailing Address
First Line	:	2161 N MULLIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2161 N MULLIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2627
Country	:	US
Telephone Number	:	773-797-6646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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