Provider Demographics
NPI:1669813937
Name:LOSE, MELISSA ANN (LCSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:LOSE
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40W222 LAFOX RD
Mailing Address - Street 2:SUITE P2
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7625
Mailing Address - Country:US
Mailing Address - Phone:630-849-3711
Mailing Address - Fax:
Practice Address - Street 1:40W222 LAFOX RD
Practice Address - Street 2:SUITE P2
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-7625
Practice Address - Country:US
Practice Address - Phone:630-849-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0159461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical