Provider Demographics
NPI:1649099920
Name:HENNIGAN, RACHEL N (EDS)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:N
Last Name:HENNIGAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:N
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6500 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2167
Mailing Address - Country:US
Mailing Address - Phone:708-256-0303
Mailing Address - Fax:
Practice Address - Street 1:6500 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2167
Practice Address - Country:US
Practice Address - Phone:708-256-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL07016218016103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool