Provider Demographics
NPI:1497843841
Name:LENNON, JULIE N (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:N
Last Name:LENNON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9126 FOUR WINDS WAY
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-676-1466
Mailing Address - Fax:847-676-0902
Practice Address - Street 1:4801 W PETERSON AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646
Practice Address - Country:US
Practice Address - Phone:773-736-9400
Practice Address - Fax:773-736-3546
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL33960230301Medicaid
L70025Medicare ID - Type Unspecified