Provider Demographics
NPI:1578076295
Name:GROENHAGEN, BRITTANY JOAN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JOAN
Last Name:GROENHAGEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:JOAN
Other - Last Name:CORCORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3294 N SILVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061-8807
Mailing Address - Country:US
Mailing Address - Phone:815-494-3743
Mailing Address - Fax:
Practice Address - Street 1:1100 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061-1533
Practice Address - Country:US
Practice Address - Phone:815-732-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist