Healthcare Provider Details

I. General information

NPI: 1588428551
Provider Name (Legal Business Name): MEGAN MAIERO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 FRONT ST STE 6
MOKENA IL
60448-1303
US

IV. Provider business mailing address

11225 FRONT ST STE 6
MOKENA IL
60448-1303
US

V. Phone/Fax

Practice location:
  • Phone: 708-620-7788
  • Fax:
Mailing address:
  • Phone: 708-620-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MEGAN MAIERO
Title or Position: OWNER
Credential: LCPC
Phone: 708-620-7788