Healthcare Provider Details

I. General information

NPI: 1427426873
Provider Name (Legal Business Name): BRETT AUSTIN VACEK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 TECH DR STE 3
BETTENDORF IA
52722-7004
US

IV. Provider business mailing address

8213 10TH ST W
ROCK ISLAND IL
61201-7744
US

V. Phone/Fax

Practice location:
  • Phone: 217-218-3456
  • Fax:
Mailing address:
  • Phone: 217-218-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180011170
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: