Individual
MEGHANN HENNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
966 W 21ST ST, CHICAGO, IL 60608
(773) 254-1400
Mailing address
966 W 21ST ST, CHICAGO, IL 60608-4511
(773) 254-1400
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036135834
IL
2084P0800X
Psychiatry Physician
60-267357
NY
2084P0804X
Child & Adolescent Psychiatry Physician
036135834
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036135834
—
IL
Enumeration date
04/22/2008
Last updated
01/08/2019
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