Healthcare Provider Details

I. General information

NPI: 1659712925
Provider Name (Legal Business Name): MEGAN ELIZABETH RIESGO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN EYRICH

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 E BUTTERFIELD RD STE 212
LOMBARD IL
60148-4879
US

IV. Provider business mailing address

477 E BUTTERFIELD RD STE 212
LOMBARD IL
60148-4879
US

V. Phone/Fax

Practice location:
  • Phone: 630-866-5666
  • Fax: 630-358-6907
Mailing address:
  • Phone: 630-866-5666
  • Fax: 630-358-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.014487
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: