Basic Information
| Provider Information | |||||||||
| NPI: | 1679769368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNING | ||||||||
| FirstName: | KATELYN | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | ATC/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 WAUKEGAN RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600252100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476579445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 WAUKEGAN RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600252100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476579445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2007 | ||||||||
| LastUpdateDate: | 09/17/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.