Healthcare Provider Details

I. General information

NPI: 1417462573
Provider Name (Legal Business Name): MEGAN CICHELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 E SCHAUMBURG RD
SCHAUMBURG IL
60194-3510
US

IV. Provider business mailing address

524 E SCHAUMBURG RD
SCHAUMBURG IL
60194-3510
US

V. Phone/Fax

Practice location:
  • Phone: 847-357-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.010904
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: