Provider Demographics
NPI:1760776918
Name:MCDERMOTT-SCHULZ, MEGGAN MARIE
Entity Type:Individual
Prefix:
First Name:MEGGAN
Middle Name:MARIE
Last Name:MCDERMOTT-SCHULZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 W STAVER ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-3727
Mailing Address - Country:US
Mailing Address - Phone:815-233-6162
Mailing Address - Fax:
Practice Address - Street 1:1134 W STAVER ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-3727
Practice Address - Country:US
Practice Address - Phone:815-233-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor