Provider Demographics
NPI:1942739925
Name:KLUG, MAYGAN MICHELE HULL (LCSW, LISW)
Entity Type:Individual
Prefix:
First Name:MAYGAN
Middle Name:MICHELE HULL
Last Name:KLUG
Suffix:
Gender:F
Credentials:LCSW, LISW
Other - Prefix:
Other - First Name:MAYGAN
Other - Middle Name:MICHELE
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LISW
Mailing Address - Street 1:200 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5674
Mailing Address - Country:US
Mailing Address - Phone:563-650-7136
Mailing Address - Fax:
Practice Address - Street 1:2701 17TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5393
Practice Address - Country:US
Practice Address - Phone:309-779-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL149.0199831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker