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Individual

BRENNA BUCKNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
15 COMMERCE DR, SUITE 111, GRAYSLAKE, IL 60030-7807
(847) 548-3458
(847) 548-3459
Mailing address
15 COMMERCE DR, SUITE 111, GRAYSLAKE, IL 60030-7807
(847) 548-3458
(847) 548-3459

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.011487
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
056.011487
STATE OF ILLINOIS
IL
Enumeration date
03/30/2016
Last updated
03/30/2016
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