Provider Demographics
NPI:1306337340
Name:HOSKINS, MEGAN (RBT-17-40711)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HOSKINS
Suffix:
Gender:F
Credentials:RBT-17-40711
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-0216
Mailing Address - Country:US
Mailing Address - Phone:815-216-1743
Mailing Address - Fax:
Practice Address - Street 1:3187 N 2420 W RD.
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:815-216-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17-40711106S00000X
IL17-40711106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician