Provider Demographics
NPI:1295259059
Name:MELCHIORI, KRISTEN ANGELA (MSW, CADC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANGELA
Last Name:MELCHIORI
Suffix:
Gender:F
Credentials:MSW, CADC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ANGELA
Other - Last Name:PORZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC
Mailing Address - Street 1:631 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4117
Mailing Address - Country:US
Mailing Address - Phone:815-756-8501
Mailing Address - Fax:815-756-5849
Practice Address - Street 1:631 S 1ST ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4117
Practice Address - Country:US
Practice Address - Phone:815-756-8501
Practice Address - Fax:815-756-5849
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL149.0219031041C0700X
IL31825101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)