MEDICARE: MS. MEGAN EILEEN HAWKSWORTH LMFT

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	106H00000X	Marriage & Family Therapist	166001071	IL
2	106H00000X	Marriage & Family Therapist	208000336	IL

General Provider Information

NPI Number	:	1689070112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MEGAN EILEEN HAWKSWORTH LMFT

Provider Business Mailing Address
First Line	:	3100 N LAKE SHORE DR APT 1902
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4909
Country	:	US
Telephone Number	:	312-620-9846
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 E WASHINGTON ST STE 1051
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1710
Country	:	US
Telephone Number	:	312-620-9846
Fax Number	:

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

Provider Enumeration Date	:	11/11/2014
Last Update Date	:	07/21/2016

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