MEDICARE: MELISSA JENNIFER SAKKOS 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	1041C0700X	Clinical Social Worker	150.104954	IL

General Provider Information

NPI Number	:	1497336358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JENNIFER SAKKOS LSW

Provider Business Mailing Address
First Line	:	125 55TH ST STE 200
Second Line	:
City	:	CLARENDON HILLS
State	:	IL
Zip	:	60514-6307
Country	:	US
Telephone Number	:	630-286-2785
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 55TH ST STE 200
Second Line	:
City	:	CLARENDON HILLS
State	:	IL
Zip	:	60514-6307
Country	:	US
Telephone Number	:	630-286-2785
Fax Number	:

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

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	05/19/2021

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