Provider Demographics
NPI:1376965004
Name:TOMASEK, MEGHAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:
Last Name:TOMASEK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:10839 S. KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655
Mailing Address - Country:US
Mailing Address - Phone:773-505-8451
Mailing Address - Fax:
Practice Address - Street 1:10839 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2107
Practice Address - Country:US
Practice Address - Phone:773-505-8451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178009582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional