Provider Demographics
NPI:1699160747
Name:MCQUILLIN, MEGAN RYAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RYAN
Last Name:MCQUILLIN
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 1:811 W EVERGREEN AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-7113
Mailing Address - Country:US
Mailing Address - Phone:330-814-6442
Mailing Address - Fax:
Practice Address - Street 1:1500 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3017
Practice Address - Country:US
Practice Address - Phone:888-972-7531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.013627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist