Provider Demographics
NPI:1679973663
Name:ANDERSON, MAEGHAN LOUISE (LSW)
Entity Type:Individual
Prefix:
First Name:MAEGHAN
Middle Name:LOUISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 REVERE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1557
Mailing Address - Country:US
Mailing Address - Phone:847-412-4350
Mailing Address - Fax:847-412-4360
Practice Address - Street 1:255 REVERE DR STE 200
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1557
Practice Address - Country:US
Practice Address - Phone:847-412-4350
Practice Address - Fax:847-412-4360
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150014885104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker