Provider Demographics
NPI:1386376788
Name:IGOE, BRENDAN JAMES
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:JAMES
Last Name:IGOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3238
Mailing Address - Country:US
Mailing Address - Phone:847-651-7874
Mailing Address - Fax:
Practice Address - Street 1:2600 EASTWOOD AVE APT D2
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1551
Practice Address - Country:US
Practice Address - Phone:847-651-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor