| Doctor Name: | KEVIN CONNOLLY |
| NPI Number: | 1124419643 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 180009277 |
| Business Practice Address: | 1 Tiffany Pt Ste 110 Bloomingdale, IL - 601082915 |
| Business Phone Number: | 7739812972 |
| Business Fax Number: | |
| Mailing Address: | 1617 Lake Ave, WILMETTE |
| State: | IL |
| Postal Code: | 600911535 |
| Phone Number: | 7739812972 |
| Fax Number: | |
| NPI Enumeration Date: | 02/06/2015 |
| NPI Last Update Date: | 02/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 180009277 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |