Provider Demographics
NPI:1154184133
Name:BRENNAN, CAROLINE ROSE (AUD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ROSE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:CALLIE
Other - Middle Name:ROSE
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:2727 W THOMAS ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-6118
Mailing Address - Country:US
Mailing Address - Phone:630-624-1630
Mailing Address - Fax:
Practice Address - Street 1:267 E WESTMINSTER
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1853
Practice Address - Country:US
Practice Address - Phone:847-295-1185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001968231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist