Provider Demographics
NPI:1609226455
Name:SHIPP, MEGAN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SHIPP
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 CHICAGO AVE
Mailing Address - Street 2:APT 2F
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4700
Mailing Address - Country:US
Mailing Address - Phone:847-942-4610
Mailing Address - Fax:
Practice Address - Street 1:1310 CHICAGO AVE
Practice Address - Street 2:APT 2F
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4700
Practice Address - Country:US
Practice Address - Phone:847-942-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0030942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer