Provider Demographics
NPI:1386171551
Name:REEDY-MCGOVERN, MEGAN (LCPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:REEDY-MCGOVERN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10136 S ARTESIAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1054
Mailing Address - Country:US
Mailing Address - Phone:773-320-7769
Mailing Address - Fax:
Practice Address - Street 1:900 RIDGE RD STE 1SW
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1934
Practice Address - Country:US
Practice Address - Phone:708-794-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006435101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180006435OtherILLINOIS DEPT. OF FINANCIAL AND PROFESSIONAL REGULATION