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NPI Code Detail

MEDICARE: BROOKE AMY O'DONNELL

MEDICARE: BROOKE AMY O'DONNELL
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
11041C0700XClinical Social Worker149031527IL

General Provider Information

NPI Number : 1861298630
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE AMY O'DONNELL
Provider Business Mailing Address
First Line : 1831 E TANO LN
Second Line :
City : MOUNT PROSPECT
State : IL
Zip : 60056-1719
Country : US
Telephone Number : 224-409-5408
Fax Number :
Provider Business Practice Location Address
First Line : 1137 MCHENRY RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-1377
Country : US
Telephone Number : 847-807-8777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2025
Last Update Date : 03/10/2026

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