Individual provider Active NPI

Melanie Johnsen

  • Clinical Social Worker
  • Naperville, IL
National Provider Identifier
1023390697
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
034006968A Issued in IN
Practice address
640 S Washington St
Naperville, IL 60540-6603
Phone
(815) 942-6323
NPI assigned
Sep 9, 2011
Last updated
Feb 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X IN
Clinical Social Worker 1041C0700X 034006968A IN Primary

Addresses

Primary practice location

640 S Washington St
Naperville, IL 60540-6603

Mailing address

PO Box 7410264
Chicago, IL 60674-0264
Phone (815) 942-6323

Other identifiers 1

IdentifierTypeStateIssuer
100270530AMedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mjohnsen205494@direct.edward.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
034006968AINMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Charities Diocese of Gary Inc Past Accepting new patients
Catholic Charities Diocese of Gary Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1023390697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7410264",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606740264",
            "telephone_number": "815-942-6323",
            "fax_number": "779-210-5541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 S WASHINGTON ST",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605406603",
            "telephone_number": "815-942-6323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSEN",
        "first_name": "MELANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-09",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "034006968A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100270530A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mjohnsen205494@direct.edward.org",
            "affiliation": "N",
            "address_1": "640 S Washington St",
            "city": "Naperville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605406603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.