MEDICARE: MEGAN K BUCKLIN LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	178-002729	IL
2	101YP2500X	Professional Counselor	180-005794	IL

General Provider Information

NPI Number	:	1033112826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN K BUCKLIN LCPC

Provider Business Mailing Address
First Line	:	197 W. HARRISON STREET
Second Line	:	SUITE 2
City	:	BOURBONNAIS
State	:	IL
Zip	:	60914
Country	:	US
Telephone Number	:	815-935-5540
Fax Number	:	815-935-5459

Provider Business Practice Location Address
First Line	:	197 W. HARRISON STREET
Second Line	:	SUITE 2
City	:	BOURBONNAIS
State	:	IL
Zip	:	60914
Country	:	US
Telephone Number	:	815-935-5540
Fax Number	:	815-935-5459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/08/2010

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