Provider Demographics
NPI:1518687250
Name:TENNIS, MEGAN (MS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:TENNIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 E PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3714
Mailing Address - Country:US
Mailing Address - Phone:630-779-9918
Mailing Address - Fax:
Practice Address - Street 1:1952 MCDOWELL ROAD
Practice Address - Street 2:UNIT 305
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-689-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health