1457689002 NPI number — MEGAN CARRICK, LLC

Table of content: (NPI 1457689002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457689002 NPI number — MEGAN CARRICK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEGAN CARRICK, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KIDS-IN-SYNC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457689002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 FRONTAGE ROAD SUITE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-784-9115
Provider Business Mailing Address Fax Number:
847-784-9330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 FRONTAGE ROAD SUITE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-784-9115
Provider Business Practice Location Address Fax Number:
847-784-9330
Provider Enumeration Date:
11/19/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARRICK-WEIMAN
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRINCIPAL
Authorized Official Telephone Number:
815-353-2129

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  056-007384 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)