Provider Demographics
NPI:1114163516
Name:NEITZEL, MEGAN M (MSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:NEITZEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 BANBURY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-4404
Mailing Address - Country:US
Mailing Address - Phone:630-740-7477
Mailing Address - Fax:
Practice Address - Street 1:7N210 BARB HILL DR
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-6804
Practice Address - Country:US
Practice Address - Phone:630-740-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor