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General NPI Number Information
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NPI Number | 1124440474
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Entity Type | Individual
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Provider Name | MONICA KANNENWISCHER
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Gender | Female
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 3033 OGDEN AVE SUITE 210
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City | LISLE
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State | IL
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Zip | 60532-1673
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Country | US
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Telephone | 815-577-3666
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Fax | 630-983-0162
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Provider Business Mailing Address
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Address Line | 3033 OGDEN AVE SUITE 210
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City | LISLE
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State | IL
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Zip | 60532-1673
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Country | US
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Telephone | 815-577-3666
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Fax | 630-983-0162
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 208.000226
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License Number State | IL
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