Healthcare Provider Details

I. General information

NPI: 1134799414
Provider Name (Legal Business Name): MEGAN RAGAN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 W MAIN ST
MARION IL
62959-1139
US

IV. Provider business mailing address

902 W MAIN ST
WEST FRANKFORT IL
62896-2210
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5336
  • Fax: 618-993-2969
Mailing address:
  • Phone: 618-937-6483
  • Fax: 618-937-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.105485
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: