Melanie Jean Nordstrom, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.010010 Issued in IL

Practice address

473 W Harrison Rd
Murphysboro, IL 62966-4782

Phone

(618) 565-2007

Fax

(618) 687-3102

NPI assigned

Aug 12, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Community Life Concepts of Southern Illinois, NPC

  dba Community Life Counseling Center

  • Clinical Social Worker
  • Murphysboro, IL
  • NPI 1336292135
  NPD (past)

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1144232638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "473 W HARRISON RD",
            "city": "MURPHYSBORO",
            "state": "IL",
            "postal_code": "629664782",
            "telephone_number": "618-565-2007",
            "fax_number": "618-687-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "473 W HARRISON RD",
            "city": "MURPHYSBORO",
            "state": "IL",
            "postal_code": "629664782",
            "telephone_number": "618-565-2007",
            "fax_number": "618-687-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDSTROM",
        "first_name": "MELANIE",
        "middle_name": "JEAN",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-12",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.010010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IL",
            "identifier": "03932042",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Murphysboro Cu SCH Dist 186
• Murphysboro Internal Medicine Clinic
• Murphysoboro Counseling Center, LLC
• Paula Monique Musumhi
• Hoai P Nguyen, DMD
• Norrenberns Foods Inc (Tom's Mad Pricer Discount Food and Drugs)
• Angela Lea O'Dell, NP
• Dana Oberg, NURSE PRACTITIONER
• Gail F Orr, RPH
• Prativa Pandey, MD

• Clinical Social Worker in Murphysboro, IL
• Providers in Murphysboro, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.