Healthcare Provider Details

I. General information

NPI: 1528986031
Provider Name (Legal Business Name): MEGAN MICHELLE SEYMORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 OLSEN DR STE 375
SAN JOSE CA
95117-1688
US

IV. Provider business mailing address

4641 ASH GROVE DR APT B1
SPRINGFIELD IL
62711-6525
US

V. Phone/Fax

Practice location:
  • Phone: 309-313-2125
  • Fax:
Mailing address:
  • Phone: 309-313-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.031857
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: