Provider Demographics
NPI:1477128478
Name:MCGANN-TAYLOR, SAMANTHA (LCSW, PEL)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MCGANN-TAYLOR
Suffix:
Gender:F
Credentials:LCSW, PEL
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:MCGANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, PEL
Mailing Address - Street 1:42 CROFTON CT
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9443
Mailing Address - Country:US
Mailing Address - Phone:708-262-8082
Mailing Address - Fax:
Practice Address - Street 1:1805 N MILL ST STE B
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4870
Practice Address - Country:US
Practice Address - Phone:630-639-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0182021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical