Provider Demographics
NPI:1164561718
Name:BRENNAN, MARY KATHERINE (MS, CCC-L)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHERINE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MS, CCC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W EXCHANGE ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-1495
Mailing Address - Country:US
Mailing Address - Phone:815-895-9227
Mailing Address - Fax:815-895-2971
Practice Address - Street 1:245 W EXCHANGE ST
Practice Address - Street 2:SUITE #4
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1495
Practice Address - Country:US
Practice Address - Phone:815-895-9227
Practice Address - Fax:815-895-2971
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist