Provider Demographics
NPI:1699663336
Name:RANDLE EL, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RANDLE EL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 MINNESOTA AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-4107
Mailing Address - Country:US
Mailing Address - Phone:708-465-4628
Mailing Address - Fax:
Practice Address - Street 1:2656 W MONTROSE AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1559
Practice Address - Country:US
Practice Address - Phone:773-267-5795
Practice Address - Fax:773-267-4787
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional