Provider Demographics
NPI:1942992425
Name:MELISSA AMISON
Entity Type:Organization
Organization Name:MELISSA AMISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMISON
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, MAEA, LCSW
Authorized Official - Phone:708-255-5053
Mailing Address - Street 1:3504 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1302
Mailing Address - Country:US
Mailing Address - Phone:708-255-5053
Mailing Address - Fax:708-255-5053
Practice Address - Street 1:3504 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1302
Practice Address - Country:US
Practice Address - Phone:708-255-5053
Practice Address - Fax:708-255-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)