Provider Demographics
NPI:1740791284
Name:PRESNAK, MELANIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:PRESNAK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N LARKIN AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3596
Mailing Address - Country:US
Mailing Address - Phone:815-741-7777
Mailing Address - Fax:815-751-7779
Practice Address - Street 1:815 N LARKIN AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3438
Practice Address - Country:US
Practice Address - Phone:815-741-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007908235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-6005654Medicaid