Provider Demographics
NPI:1285022244
Name:STICKELMAIER, MEGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:STICKELMAIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:SEAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:12519 N FILLYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-9393
Mailing Address - Country:US
Mailing Address - Phone:309-863-3513
Mailing Address - Fax:
Practice Address - Street 1:4450 N PROSPECT RD
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-6578
Practice Address - Country:US
Practice Address - Phone:309-863-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0171411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical