Healthcare Provider Details

I. General information

NPI: 1679280119
Provider Name (Legal Business Name): MEGAN OLEJNIK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SPRING CREEK RD STE 15
ROCKFORD IL
61107-1157
US

IV. Provider business mailing address

210 S GARDINER AVE
ROCKFORD IL
61104-2410
US

V. Phone/Fax

Practice location:
  • Phone: 815-670-7965
  • Fax:
Mailing address:
  • Phone: 815-670-7965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149028138
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150109519
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: