MEDICARE: MEGAN NICOLE MORIEN BCBA

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	103K00000X	Behavior Analyst	1-10-7536	IL

General Provider Information

NPI Number	:	1417470576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN NICOLE MORIEN BCBA

Provider Business Mailing Address
First Line	:	1422 W WILLOW ST STE 203
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-8977
Country	:	US
Telephone Number	:	773-630-4400
Fax Number	:	312-278-0072

Provider Business Practice Location Address
First Line	:	1422 W WILLOW ST STE 203
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-8977
Country	:	US
Telephone Number	:	773-630-4400
Fax Number	:	312-278-0072

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

Provider Enumeration Date	:	07/20/2017
Last Update Date	:	07/21/2022

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