Provider Demographics
NPI:1104187582
Name:BRENNAN, MAREDITH (BA, CHFS, CGP)
Entity Type:Individual
Prefix:
First Name:MAREDITH
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:BA, CHFS, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 CHURCHILL LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-1301
Mailing Address - Country:US
Mailing Address - Phone:630-774-0262
Mailing Address - Fax:
Practice Address - Street 1:1789 CHURCHILL LN
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1301
Practice Address - Country:US
Practice Address - Phone:630-774-0262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-02
Last Update Date:2012-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education