Provider Demographics
NPI:1811164783
Name:KOSTIAL-JANOS, MELISSA SUSAN (LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUSAN
Last Name:KOSTIAL-JANOS
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 BLUE HERON CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-6403
Mailing Address - Country:US
Mailing Address - Phone:708-308-3938
Mailing Address - Fax:
Practice Address - Street 1:135 N GREENLEAF ST
Practice Address - Street 2:STE 228
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3393
Practice Address - Country:US
Practice Address - Phone:224-603-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-10
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089767101YM0800X
IL149001506101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health