Healthcare Provider Details

I. General information

NPI: 1053013334
Provider Name (Legal Business Name): MCKAYLA P FATA MSW, LSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MCKAYLA SCROGGINS

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E MERCHANTS RD SUITE 300
OSWEGO IL
60543
US

IV. Provider business mailing address

1 E MERCHANTS RD SUITE 300
OSWEGO IL
60543
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax: 630-428-7891
Mailing address:
  • Phone: 630-428-7890
  • Fax: 630-428-7891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number150114286
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149041277
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: