Provider Demographics
NPI:1902113566
Name:BRENNAN, MEGAN KELLY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:KELLY
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4453 N ROCKWELL ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3057
Mailing Address - Country:US
Mailing Address - Phone:773-895-2125
Mailing Address - Fax:773-257-5330
Practice Address - Street 1:4453 N ROCKWELL ST
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3057
Practice Address - Country:US
Practice Address - Phone:773-895-2125
Practice Address - Fax:773-257-5330
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional