Healthcare Provider Details

I. General information

NPI: 1356873251
Provider Name (Legal Business Name): CATHERINE MARTHA MCGLONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 FOX DR
CHAMPAIGN IL
61820-7236
US

IV. Provider business mailing address

3911 SANDSTONE DR
CHAMPAIGN IL
61822-2043
US

V. Phone/Fax

Practice location:
  • Phone: 217-398-8080
  • Fax:
Mailing address:
  • Phone: 217-649-2071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: