Healthcare Provider Details

I. General information

NPI: 1477274546
Provider Name (Legal Business Name): VANESSA ANN BRINKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 07/08/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S RIVER ST
AURORA IL
60506-5185
US

IV. Provider business mailing address

4615 W 103RD ST
OAK LAWN IL
60453-4718
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-2662
  • Fax: 630-844-3084
Mailing address:
  • Phone: 331-229-8843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: