Healthcare Provider Details

I. General information

NPI: 1912838541
Provider Name (Legal Business Name): MEGAN GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2852 N WESTERN AVE
CHICAGO IL
60618-8019
US

IV. Provider business mailing address

1637 W CULLERTON ST # 1
CHICAGO IL
60608-2907
US

V. Phone/Fax

Practice location:
  • Phone: 815-685-4500
  • Fax:
Mailing address:
  • Phone: 815-685-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: