Provider Demographics
NPI:1609322353
Name:GUZICKI, MELISSA (LCPC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:GUZICKI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 N KOSTNER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-1610
Mailing Address - Country:US
Mailing Address - Phone:312-216-8020
Mailing Address - Fax:
Practice Address - Street 1:1520 NORTH KOSTN
Practice Address - Street 2:NEAR NORTH HEALTH CENTER -NORTH KOSTNER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615
Practice Address - Country:US
Practice Address - Phone:312-216-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.007892Medicaid