=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295956845
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN RYAN MS, CRC, LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 01/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1283 ANGELINE DR.
-----------------------------------------------------
City | SOUTH ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-514-2397
-----------------------------------------------------
Fax | 312-528-9199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1283 ANGELINE DR.
-----------------------------------------------------
City | SOUTH ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-514-2397
-----------------------------------------------------
Fax | 312-528-9199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180.006466
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------