Healthcare Provider Details

I. General information

NPI: 1225990161
Provider Name (Legal Business Name): MAYA MCGREGOR LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 GRANT ST
CRYSTAL LAKE IL
60014-4372
US

IV. Provider business mailing address

123 EDGEWOOD AVE
CRYSTAL LAKE IL
60014-5227
US

V. Phone/Fax

Practice location:
  • Phone: 815-276-3947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.110607
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: