Provider Demographics
NPI:1922710979
Name:MELGAR, SOLEDAD MARIA (LSW)
Entity Type:Individual
Prefix:
First Name:SOLEDAD
Middle Name:MARIA
Last Name:MELGAR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6149 S KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5209
Mailing Address - Country:US
Mailing Address - Phone:773-581-4357
Mailing Address - Fax:773-498-7186
Practice Address - Street 1:33 N COUNTY ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4315
Practice Address - Country:US
Practice Address - Phone:773-581-4357
Practice Address - Fax:773-498-7186
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150106682104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker