=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396607206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CONNECTED SELF PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2025
-----------------------------------------------------
Last Update Date | 11/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 N HAZEL ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60613-1289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-365-8485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1440 W TAYLOR ST # 636
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-4623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-365-8485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW
-----------------------------------------------------
Name | MEGAN SZUDARSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-365-8485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------