Provider Demographics
NPI:1407621923
Name:MEEHAN, ELIZABETH KENDEE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KENDEE
Last Name:MEEHAN
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 1:1721 MOON LAKE BLVD STE 130140
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1069
Mailing Address - Country:US
Mailing Address - Phone:478-334-2824
Mailing Address - Fax:
Practice Address - Street 1:1721 MOON LAKE BLVD STE 130140
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1069
Practice Address - Country:US
Practice Address - Phone:478-334-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician