Provider Demographics
NPI:1154998342
Name:MCGUIRE, JARRYD EDWARD (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:JARRYD
Middle Name:EDWARD
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1739
Mailing Address - Country:US
Mailing Address - Phone:815-408-0988
Mailing Address - Fax:815-408-1081
Practice Address - Street 1:125 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1739
Practice Address - Country:US
Practice Address - Phone:815-408-0988
Practice Address - Fax:815-408-1081
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA167322163W00000X
IL041.429974163W00000X
IAG167535363LP0808X
IL277002764363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse