Glen Sekou Fondren, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

104100000X Issued in IL

Practice address

1414 Main St
Melrose Park, IL 60160-3902

Phone

(708) 681-0073

NPI assigned

Dec 7, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: glen.fondren.1@21300.direct.athenahealth.com

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.

• Presence Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Melrose Park, IL
  • NPI 1477622298
  Medicare reassignment NPD

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

{
    "created_epoch": "1323216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1275801110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 MAIN ST",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601603902",
            "telephone_number": "708-681-0073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 MAIN ST",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601603902",
            "telephone_number": "708-681-0073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONDREN",
        "first_name": "GLEN",
        "middle_name": "SEKOU",
        "name_prefix": "Mr.",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-07",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "104100000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Flawless Service Corporation
• Flor D. Loya, D.D.S., LTD
• Kelsey Florczak
• David Alonso Flores
• Erica L Flynn, CRNA
• Michelle Onyinye Forson, M.D
• Kelsey Foster
• Tanya Foster
• Four Star RX Inc
• Roxanna Franco, MSW

• Social Worker in Melrose Park, IL
• Providers in Melrose Park, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.