Provider Demographics
NPI:1174884514
Name:MCCONNELL, JOHN M (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E OGDEN AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3546
Mailing Address - Country:US
Mailing Address - Phone:630-325-5300
Mailing Address - Fax:630-325-5309
Practice Address - Street 1:501 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5501
Practice Address - Country:US
Practice Address - Phone:630-752-5762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042890A103TC0700X
IL071.009392103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical