NPIMap

Organization Active NPI

Meredith Bolan Therapy, LLC

  • Clinical Social Worker
  • La Grange, IL
National Provider Identifier
1114596277
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MEREDITH BOLAN THERAPY, LLC
Practice address
82 S la Grange Rd Ste 210
La Grange, IL 60525-6348
Phone
(630) 446-0407
NPI assigned
Jun 23, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Meredith BolanNPI 1689259624
Title
Owner
Phone
(708) 528-5374

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

82 S la Grange Rd Ste 210
La Grange, IL 60525-6348

Mailing address

920 N Spring Ave
La Grange Park, IL 60526-1477
Phone (708) 528-5374

Other identifiers 1

IdentifierTypeStateIssuer
149021859OtherILLICENSE NUMBER

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://meredith-bolan.clientsecure.me/

National Provider Directory

National Provider Directory

Locations

82 S La Grange Rd
Ste 210
La Grange, IL 60525
Phone (630) 446-0407

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624406400000",
    "number": "1114596277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 N SPRING AVE",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605261477",
            "telephone_number": "708-528-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 S LA GRANGE RD STE 210",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605256348",
            "telephone_number": "630-446-0407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEREDITH BOLAN THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-23",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A",
        "authorized_official_last_name": "BOLAN",
        "authorized_official_first_name": "MEREDITH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-528-5374"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "149021859",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://meredith-bolan.clientsecure.me/",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "82 S La Grange Rd Ste 210",
            "city": "LA Grange",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605256348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in La Grange, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.