Provider Demographics
NPI:1538658562
Name:MEGHAN ROEKLE, PSYD, LLC
Entity Type:Organization
Organization Name:MEGHAN ROEKLE, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:ROEKLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCP
Authorized Official - Phone:312-217-3127
Mailing Address - Street 1:561 W DIVERSEY PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1682
Mailing Address - Country:US
Mailing Address - Phone:312-217-3127
Mailing Address - Fax:
Practice Address - Street 1:561 W DIVERSEY PKWY STE 210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1682
Practice Address - Country:US
Practice Address - Phone:312-217-3127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006852103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty