Provider Demographics
NPI:1730215625
Name:MCGOVERN, MEGHAN MARIE (MS, ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:MARIE
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 DUNDEE DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-7705
Mailing Address - Country:US
Mailing Address - Phone:708-805-0230
Mailing Address - Fax:
Practice Address - Street 1:6105 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2313
Practice Address - Country:US
Practice Address - Phone:773-279-0927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960015332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer