Healthcare Provider Details

I. General information

NPI: 1457846636
Provider Name (Legal Business Name): MEGAN MANTILLA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN LOSIK

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1829 CANTERFIELD PKWY W
WEST DUNDEE IL
60118-9021
US

IV. Provider business mailing address

244 S RANDALL RD
ELGIN IL
60123-5529
US

V. Phone/Fax

Practice location:
  • Phone: 224-223-1144
  • Fax:
Mailing address:
  • Phone: 224-223-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801108376
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9644
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095794
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200002376
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012010A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTLS213CP
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30037
License Number StateMD
# 8
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.025209
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014947
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: