Individual
JOHNATHAN BRENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, ED.S.
Contact information
Practice address
125 FAIRFIELD WAY, BLOOMINGDALE, IL 60108-1597
(630) 440-5406
Mailing address
1691 JOSEPH CT, BUFFALO GROVE, IL 60089-6892
(847) 778-7156
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
2056540
IL
Other
Enumeration date
07/20/2017
Last updated
07/20/2017
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