Provider Demographics
NPI:1487187654
Name:MCHUGH, KELLY BRENNA (MS, CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:BRENNA
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 N LAKEWOOD AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3202
Mailing Address - Country:US
Mailing Address - Phone:630-333-3146
Mailing Address - Fax:
Practice Address - Street 1:657 W BITTERSWEET PL # 2W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2307
Practice Address - Country:US
Practice Address - Phone:630-333-3146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist