Provider Demographics
NPI:1922019223
Name:CRONWALL, MELINDA MARIE (MA)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:MARIE
Last Name:CRONWALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21362 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3004
Mailing Address - Country:US
Mailing Address - Phone:708-873-0170
Mailing Address - Fax:708-873-0417
Practice Address - Street 1:9601 W. 165 ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-873-0170
Practice Address - Fax:708-873-0417
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health