Provider Demographics
NPI:1891165890
Name:DAMRONGVACHIRAPHAN, MELISSA RAMOS (MS, CGC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAMOS
Last Name:DAMRONGVACHIRAPHAN
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:APRIL
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:4240 N KENMORE AVE APT 4S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1399
Mailing Address - Country:US
Mailing Address - Phone:313-400-8480
Mailing Address - Fax:
Practice Address - Street 1:259 E ERIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2987
Practice Address - Country:US
Practice Address - Phone:312-926-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246000189170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS