Provider Demographics
NPI:1326182924
Name:LENNON, PHILLIP PATRICK (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:PATRICK
Last Name:LENNON
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:DR
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:LENNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 824
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-0824
Mailing Address - Country:US
Mailing Address - Phone:630-901-3223
Mailing Address - Fax:630-375-2932
Practice Address - Street 1:2020 OGDEN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5894
Practice Address - Country:US
Practice Address - Phone:630-499-4703
Practice Address - Fax:630-375-2932
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004851041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical