Provider Demographics
NPI:1659712925
Name:RIESGO, MEGAN ELIZABETH (LCPC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:RIESGO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:EYRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:477 E BUTTERFIELD RD STE 212
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4879
Mailing Address - Country:US
Mailing Address - Phone:630-866-5666
Mailing Address - Fax:630-358-6907
Practice Address - Street 1:477 E BUTTERFIELD RD STE 212
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4879
Practice Address - Country:US
Practice Address - Phone:630-866-5666
Practice Address - Fax:630-358-6907
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL180.014487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program