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Individual

KELLY LENNEMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3749 W 95TH ST, EVERGREEN PARK, IL 60805-2019
(844) 372-7672
Mailing address
2647 S XENON WAY, LAKEWOOD, CO 80228-4941

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
IL
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
08/06/2021
Last updated
12/08/2021
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