Provider Demographics
NPI:1962668020
Name:MARGOL, AUDREY NAUTA (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:NAUTA
Last Name:MARGOL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E GOLF RD
Mailing Address - Street 2:SUITE 1127
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5700
Mailing Address - Country:US
Mailing Address - Phone:847-981-9200
Mailing Address - Fax:847-981-9322
Practice Address - Street 1:825 E GOLF RD
Practice Address - Street 2:SUITE 1127
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5700
Practice Address - Country:US
Practice Address - Phone:847-981-9200
Practice Address - Fax:847-981-9322
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL589170Medicare PIN