Individual
MELISSA N JENDUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
5702 ELAINE DR STE 108, ROCKFORD, IL 61108-2458
(779) 901-0792
Mailing address
107 MEDINA ST, DURAND, IL 61024-8925
(815) 742-1816
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
33244
IL
Other
Enumeration date
09/01/2021
Last updated
09/01/2021
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