Provider Demographics
NPI:1104370121
Name:ROSECRANS, MEGAN DOLORES
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:DOLORES
Last Name:ROSECRANS
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 1:1457 MERCHANT DR STE C
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5917
Mailing Address - Country:US
Mailing Address - Phone:847-461-8414
Mailing Address - Fax:847-461-8387
Practice Address - Street 1:1457 MERCHANT DR STE C
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5917
Practice Address - Country:US
Practice Address - Phone:847-461-8414
Practice Address - Fax:847-461-8384
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth