Provider Demographics
NPI:1881625176
Name:MCKEOGH, CONNIE (LCSW)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:MCKEOGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:R
Other - Last Name:MCKEOGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4927 LICHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5615
Mailing Address - Country:US
Mailing Address - Phone:847-845-8033
Mailing Address - Fax:
Practice Address - Street 1:4927 LICHFIELD DR
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60010-5615
Practice Address - Country:US
Practice Address - Phone:847-845-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-009219104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ68220Medicare UPIN
ILK27221Medicare ID - Type UnspecifiedMEDICARE #