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NPI Code Detail

MEDICARE: COLLEEN MARY BRENNAN M.S.CCC-SLP

MEDICARE: COLLEEN MARY BRENNAN M.S.CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist146-004747IL

General Provider Information

NPI Number : 1164667093
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN MARY BRENNAN M.S.CCC-SLP
Provider Business Mailing Address
First Line : 1934 W WELLINGTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4030
Country : US
Telephone Number : 773-525-2363
Fax Number :
Provider Business Practice Location Address
First Line : 1934 W WELLINGTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4030
Country : US
Telephone Number : 773-525-2363
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2008
Last Update Date : 12/05/2008

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Directions to “ COLLEEN MARY BRENNAN M.S.CCC-SLP” Practice Location

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