Provider Demographics
NPI:1811018385
Name:KEENAN, KATHRYN (PHD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 HARVESTER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5993
Mailing Address - Country:US
Mailing Address - Phone:773-834-1061
Mailing Address - Fax:773-834-0946
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 3077
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-6751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILS66878Medicare UPIN
ILL82900Medicare ID - Type Unspecified