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General NPI Number Information
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NPI Number | 1962706077
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Entity Type | Organization
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Legal Business Name | PATRICIA M EGAN AND ASSOCIATES LLC
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 3000 HIGHLAND VIEW DR
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City | FREEPORT
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State | IL
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Zip | 61032-6936
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Country | US
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Telephone | 815-297-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 HIGHLAND VIEW DR
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City | FREEPORT
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State | IL
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Zip | 61032-6936
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Country | US
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Telephone | 815-297-8400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA M EGAN
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Credential | PSYD
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Telephone | 815-297-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007492
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License Number State | IL
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