Provider Demographics
NPI:1285221002
Name:MESIROW, MEAGAN KAYLA (LSW)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:KAYLA
Last Name:MESIROW
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 N SHERIDAN RD APT 1127
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5829
Mailing Address - Country:US
Mailing Address - Phone:847-707-6873
Mailing Address - Fax:
Practice Address - Street 1:2150 W LAWRENCE AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1582
Practice Address - Country:US
Practice Address - Phone:773-887-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150103702104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker