Provider Demographics
NPI:1144954637
Name:BRENNAN, EMILY CLAIRE
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:CLAIRE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 MONTICELLO PL
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1745
Mailing Address - Country:US
Mailing Address - Phone:616-240-3347
Mailing Address - Fax:
Practice Address - Street 1:521 S LA GRANGE RD STE 201
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5633
Practice Address - Country:US
Practice Address - Phone:312-741-3218
Practice Address - Fax:773-233-6111
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty