MR. GLEN SEKOU FONDREN LSW
NPI 1275801110
Social Worker in Melrose Park, IL

Q: What is Glen Fondren's NPI number?

The NPI number for Glen Fondren is 1275801110. It was assigned to this individual provider in the NPPES registry on December 7, 2011.

Q: What is Glen Fondren's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

Q: When was this NPI record last updated?

The NPPES record for Glen Fondren was last updated on September 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 07, 2011PECOS Enrolled

1414 MAIN ST, MELROSE PARK, IL 60160(708) 681-0073 Get Directions Write a Review

NPPES record last updated: September 17, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Mr. Glen Sekou Fondren Lsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. GLEN SEKOU FONDREN LSW (NPI 1275801110) is an individual social worker in Melrose Park, Illinois, licensed in Illinois (104100000X) and active in the NPI registry since December 2011. He is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1275801110

Entity TypeIndividualMale

Primary Taxonomy104100000X

Provider Legal NameMR. GLEN SEKOU FONDRENCredential: LSW

Location Address1414 MAIN STMelrose Park, IL 60160-3902

Mailing Address1414 Main StMelrose Park, IL 60160-3902 · (708) 681-0073

Phone(708) 681-0073

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateDecember 7, 2011

Last NPPES UpdateSeptember 17, 2024

NPPES CertifiedSeptember 17, 2024

✔ NPI 1275801110 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers

Taxonomy Code104100000X

License✔ Licensed in IL · 104100000X

Definition

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.

1414 MAIN ST, Melrose Park, IL 60160

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Glen Sekou Fondren Lsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4880196344

PECOS Enrollment IDI20250904004853

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. JASON PETER SCHALLACK MFA

Counselor (Mental Health)