Healthcare Provider Details

I. General information

NPI: 1649943374
Provider Name (Legal Business Name): MEGAN NANNARONE TAGGART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MICHIGAN AVE STE 9012
CHICAGO IL
60601-7713
US

IV. Provider business mailing address

155 N MICHIGAN AVE STE 9012
CHICAGO IL
60601-7713
US

V. Phone/Fax

Practice location:
  • Phone: 331-240-0044
  • Fax: 312-674-7470
Mailing address:
  • Phone: 331-240-0044
  • Fax: 312-674-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149018236
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: