Provider Demographics
NPI:1346745916
Name:MCGOWAN, GENEEN RENEE
Entity Type:Individual
Prefix:MISS
First Name:GENEEN
Middle Name:RENEE
Last Name:MCGOWAN
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 1:7050 S MERRILL AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2181
Mailing Address - Country:US
Mailing Address - Phone:773-699-1986
Mailing Address - Fax:773-420-3555
Practice Address - Street 1:7050 S MERRILL AVE APT 405
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2181
Practice Address - Country:US
Practice Address - Phone:773-699-1986
Practice Address - Fax:773-420-3555
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.103057104100000X
IL149.0250791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty