Megan Collazo

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.012952 Issued in IL

Practice address

102 W Kenwood Ave Ste 120
Decatur, IL 62526-6380

Phone

(218) 405-0321

NPI assigned

May 5, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: lifestancehealth.meganboeddeker@146897.advancedmd-direct.com

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

{
    "created_epoch": "1588636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1194346825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 COUNTRY CLUB CT",
            "city": "LE CLAIRE",
            "state": "IA",
            "postal_code": "527539268",
            "telephone_number": "218-405-0321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W KENWOOD AVE STE 120",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625266380",
            "telephone_number": "218-405-0321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLAZO",
        "first_name": "MEGAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-05",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.015008",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.012952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald N. Cole, DMD
• Tykyna C.H. Cole, LCPC
• Dale Colee
• Benjamin Robert Coleman, MD
• Felicia Coleman, RBT
• Anthony F Collins, M.D.
• Kevin Collins, NP
• Claudia Colombo, PHARM.D.
• Douglas Venice Combs, M.D.
• Community Health Improvement Center

• Professional Counselor in Decatur, IL
• Providers in Decatur, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; 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.