Most Relevant Information
Provider Data
| NPI Number: | 1003051574 |
| Provider Name: | KEVIN JAMES BRANNICK LPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 178002986 |
Most Important Dates
| Enumeration Date: | 12/11/2008 |
| Last Updated: | 12/11/2008 |
Provider Practice Location
3200 HARLEM AVE
RIVERSIDE
IL
605462012
Practice Location Phone/Fax
| Phone: | 7084472468 |
| Fax: | 7084470043 |
Provider Mailing Location
3200 HARLEM AVE
RIVERSIDE
IL
605462012
Provider Mailing Phone/Fax
| Phone: | 7084472468 |
| Fax: | 7084470043 |