Basic Information
| Provider Information | |||||||||
| NPI: | 1679857577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEWEY | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 742 ESSINGTON RD | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604354912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152205637 | ||||||||
| FaxNumber: | 8153730099 | ||||||||
| Practice Location | |||||||||
| Address1: | 742 ESSINGTON RD | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604354912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152205632 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2011 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 178.006467 | IL | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 180.008107 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.