Individual
MEGAN PROVENZALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4201 LACEY RD, DOWNERS GROVE, IL 60515-1839
(630) 551-6044
Mailing address
4201 LACEY RD, DOWNERS GROVE, IL 60515-1839
(630) 551-6044
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
02/01/2023
Last updated
02/01/2023
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