MEDICARE: MARY NAUGLE LCPC, LCSW

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	180003366	IL
2	1041C0700X	Clinical Social Worker	149009793	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10126478	OTHER	IL	BLUE SHIELD OF IL PROV #
2	175274	OTHER	IL	COM PSYCH
3	7200619	OTHER	IL	AETNA PROVIDER #

General Provider Information

NPI Number	:	1881639292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY NAUGLE LCPC, LCSW

Provider Business Mailing Address
First Line	:	7225 FOREST HILLS RD
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-4374
Country	:	US
Telephone Number	:	815-877-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	7225 FOREST HILLS RD
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-4374
Country	:	US
Telephone Number	:	815-877-0900
Fax Number	:

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	04/13/2023

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