MEDICARE: DR. MEGHAN T KENNEDY PSYD

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	103TC0700X	Clinical Psychologist	071009748	IL

General Provider Information

NPI Number	:	1720431026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGHAN T KENNEDY PSYD

Provider Business Mailing Address
First Line	:	4055 S ROUTE 59 STE 100
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-5804
Country	:	US
Telephone Number	:	630-358-9750
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 S ROUTE 59 STE 100
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-5804
Country	:	US
Telephone Number	:	630-358-9750
Fax Number	:

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

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	03/04/2026

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