Provider Demographics
NPI:1750537502
Name:EGAN, PATRICIA (PSYD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:EGAN
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 1:1011 LORAS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6900
Mailing Address - Country:US
Mailing Address - Phone:815-297-8400
Mailing Address - Fax:
Practice Address - Street 1:1011 LORAS DR
Practice Address - Street 2:SUITE C
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6900
Practice Address - Country:US
Practice Address - Phone:815-297-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical