Provider Demographics
NPI:1033112826
Name:BUCKLIN, MEGAN K (LCPC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:K
Last Name:BUCKLIN
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 1:197 W. HARRISON STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914
Mailing Address - Country:US
Mailing Address - Phone:815-935-5540
Mailing Address - Fax:815-935-5459
Practice Address - Street 1:197 W. HARRISON STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:815-935-5540
Practice Address - Fax:815-935-5459
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178-002729101YP2500X
IL180-005794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional