Provider Demographics
NPI:1770860660
Name:MCGUIRE, PATRICIA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:S
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 W SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-2739
Mailing Address - Country:US
Mailing Address - Phone:217-428-2405
Mailing Address - Fax:
Practice Address - Street 1:1477 W SUNSET AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-2739
Practice Address - Country:US
Practice Address - Phone:217-428-2405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-06-2948103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst