MEDICARE: MS. MELINDA ALICE MARX MSW

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	149006137	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001633978	OTHER	IL	BCBS PROVIDER #

General Provider Information

NPI Number	:	1851352801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELINDA ALICE MARX MSW

Provider Business Mailing Address
First Line	:	2455 PRAIRIE AVE APT 2A
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-2267
Country	:	US
Telephone Number	:	847-483-9701
Fax Number	:	847-483-9702

Provider Business Practice Location Address
First Line	:	355 W DUNDEE RD STE 214
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-3500
Country	:	US
Telephone Number	:	847-483-9701
Fax Number	:	847-483-9701

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	07/13/2021

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