Provider Demographics
NPI:1851352801
Name:MARX, MELINDA ALICE (MSW)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:ALICE
Last Name:MARX
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:MARX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2455 PRAIRIE AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2267
Mailing Address - Country:US
Mailing Address - Phone:847-483-9701
Mailing Address - Fax:847-483-9702
Practice Address - Street 1:355 W DUNDEE RD STE 214
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3500
Practice Address - Country:US
Practice Address - Phone:847-483-9701
Practice Address - Fax:847-483-9701
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490061371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001633978OtherBCBS PROVIDER #