Healthcare Provider Details

I. General information

NPI: 1972167690
Provider Name (Legal Business Name): MEGAN ELIZABETH GROVE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E. 1ST ST.
DIXON IL
61021
US

IV. Provider business mailing address

403 E. 1ST ST.
DIXON IL
61021
US

V. Phone/Fax

Practice location:
  • Phone: 815-285-5636
  • Fax: 815-285-5850
Mailing address:
  • Phone: 815-285-5636
  • Fax: 815-285-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: