Provider Demographics
NPI:1326343344
Name:TONDU, MEGAN ROEHRIG (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ROEHRIG
Last Name:TONDU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:ROEHRIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1910 1ST ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3144
Mailing Address - Country:US
Mailing Address - Phone:847-926-7781
Mailing Address - Fax:847-926-7736
Practice Address - Street 1:1910 1ST ST
Practice Address - Street 2:SUITE 302
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3144
Practice Address - Country:US
Practice Address - Phone:847-926-7781
Practice Address - Fax:847-926-7736
Is Sole Proprietor?:No
Enumeration Date:2011-01-22
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007970103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical