Provider Demographics
NPI:1780199810
Name:CONLON, BRENNA MAUREEN (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:BRENNA
Middle Name:MAUREEN
Last Name:CONLON
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8941 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1232
Mailing Address - Country:US
Mailing Address - Phone:708-790-2604
Mailing Address - Fax:
Practice Address - Street 1:3621 151ST ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-3701
Practice Address - Country:US
Practice Address - Phone:708-385-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist