MEDICARE: MEGAN POLCHOPEK 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

General Provider Information

NPI Number	:	1568018547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN POLCHOPEK BCBA

Provider Business Mailing Address
First Line	:	3816 N DAMEN AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3904
Country	:	US
Telephone Number	:	708-703-7746
Fax Number	:

Provider Business Practice Location Address
First Line	:	3816 N DAMEN AVE # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3904
Country	:	US
Telephone Number	:	708-703-7746
Fax Number	:

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

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	08/14/2019

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