Provider Demographics
NPI:1316328859
Name:HAGEMASTER, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HAGEMASTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17150 S MCCARRON RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8251
Mailing Address - Country:US
Mailing Address - Phone:708-769-2689
Mailing Address - Fax:
Practice Address - Street 1:123 E 9TH ST
Practice Address - Street 2:STE 1B
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3691
Practice Address - Country:US
Practice Address - Phone:630-324-8298
Practice Address - Fax:815-346-5320
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0175941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical