Individual
JENNIFER S MELLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
518 LUCINDA AVE, NIU HEALTH SERVICES, DEKALB, IL 60115
(815) 753-9587
Mailing address
1401 LAKEWOOD DR, STE A, MORRIS, IL 60450-3352
(815) 942-6323
(815) 942-6323
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036111512
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CE9335
RR GROUP
IL
01
—
P00345212
RR MEDICARE #
IL
Enumeration date
07/19/2006
Last updated
11/14/2016
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