Provider Demographics
NPI:1710994512
Name:MCGRATH, PENNY S (MA)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:S
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 S 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2407
Mailing Address - Country:US
Mailing Address - Phone:708-425-0310
Mailing Address - Fax:708-425-0411
Practice Address - Street 1:9411 S 51ST AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2407
Practice Address - Country:US
Practice Address - Phone:708-425-0310
Practice Address - Fax:708-425-0411
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional