MEDICARE: MEGAN STICKELMAIER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.017141	IL

General Provider Information

NPI Number	:	1285022244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN STICKELMAIER LCSW

Provider Business Mailing Address
First Line	:	12519 N FILLYSIDE DR
Second Line	:
City	:	DUNLAP
State	:	IL
Zip	:	61525-9393
Country	:	US
Telephone Number	:	309-863-3513
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 N PROSPECT RD
Second Line	:
City	:	PEORIA HEIGHTS
State	:	IL
Zip	:	61616-6578
Country	:	US
Telephone Number	:	309-863-5133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2014
Last Update Date	:	04/10/2018

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