Provider Demographics
NPI:1942663349
Name:KANNAPPAN, MARYANN
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:KANNAPPAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8251 S RHODES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5005
Mailing Address - Country:US
Mailing Address - Phone:773-818-9607
Mailing Address - Fax:
Practice Address - Street 1:8251 S RHODES AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-5005
Practice Address - Country:US
Practice Address - Phone:773-818-9607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.009309104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker