Provider Demographics
NPI:1578372645
Name:MCNICHOLAS, MEGHAN HART
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:HART
Last Name:MCNICHOLAS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:HART
Other - Middle Name:
Other - Last Name:MCNICHOLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:456 N RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2218
Mailing Address - Country:US
Mailing Address - Phone:630-202-1461
Mailing Address - Fax:
Practice Address - Street 1:1757 N KIMBALL AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4805
Practice Address - Country:US
Practice Address - Phone:872-246-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health