MEDICARE: MELINDA SUE MATHEWS MA, LCPC

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	101YP2500X	Professional Counselor	180006899	IL

General Provider Information

NPI Number	:	1457518805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA SUE MATHEWS MA, LCPC

Provider Business Mailing Address
First Line	:	109 LAKESIDE DR
Second Line	:	APARTMENT 232
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-7903
Country	:	US
Telephone Number	:	630-443-8135
Fax Number	:	630-941-7944

Provider Business Practice Location Address
First Line	:	116 S YORK RD
Second Line	:	SUITE 215
City	:	ELMHURST
State	:	IL
Zip	:	60126-3432
Country	:	US
Telephone Number	:	630-204-3160
Fax Number	:	630-941-7944

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/21/2008

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