Provider Demographics
NPI:1437877040
Name:BRUNS, KATY MARIE O'HANLON
Entity Type:Individual
Prefix:MRS
First Name:KATY MARIE
Middle Name:O'HANLON
Last Name:BRUNS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATY
Other - Middle Name:MARIE
Other - Last Name:HANLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1802 W BERTEAU AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6182
Mailing Address - Country:US
Mailing Address - Phone:708-568-1557
Mailing Address - Fax:
Practice Address - Street 1:1802 W BERTEAU AVE STE 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6182
Practice Address - Country:US
Practice Address - Phone:708-568-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1649518515OtherNPI