Provider Demographics
NPI:1063166478
Name:MEYER, GEORGINA (LSW)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36W553 BARTON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6313
Mailing Address - Country:US
Mailing Address - Phone:630-885-5642
Mailing Address - Fax:
Practice Address - Street 1:3100 W HIGGINS RD STE 190
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7252
Practice Address - Country:US
Practice Address - Phone:630-686-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.008319104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker