Healthcare Provider Details

I. General information

NPI: 1154184133
Provider Name (Legal Business Name): CAROLINE ROSE BRENNAN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALLIE ROSE BRENNAN AUD

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 S MARYLAND AVE DCAM 4H
CHICAGO IL
60637
US

IV. Provider business mailing address

2727 W THOMAS ST APT 1
CHICAGO IL
60622-6118
US

V. Phone/Fax

Practice location:
  • Phone: 773-834-9456
  • Fax:
Mailing address:
  • Phone: 630-624-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.001968
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: