Provider Demographics
NPI:1750730842
Name:PORTER-MANN, MEGAN (RN, LCPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PORTER-MANN
Suffix:
Gender:F
Credentials:RN, LCPC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LCPC
Mailing Address - Street 1:1440 RENAISSANCE DR
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1356
Mailing Address - Country:US
Mailing Address - Phone:847-759-9110
Mailing Address - Fax:
Practice Address - Street 1:1440 RENAISSANCE DR
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1356
Practice Address - Country:US
Practice Address - Phone:847-759-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008250101YP2500X
IL180014923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional