Healthcare Provider Details

I. General information

NPI: 1295956845
Provider Name (Legal Business Name): MEGAN RYAN MS, CRC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 ANGELINE DR.
SOUTH ELGIN IL
60177
US

IV. Provider business mailing address

1283 ANGELINE DR.
SOUTH ELGIN IL
60177
US

V. Phone/Fax

Practice location:
  • Phone: 847-514-2397
  • Fax: 312-528-9199
Mailing address:
  • Phone: 847-514-2397
  • Fax: 312-528-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.006466
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: