Healthcare Provider Details

I. General information

NPI: 1639004674
Provider Name (Legal Business Name): JOSHUA A BRACKEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 QUADRANGLE DR STE K
BOLINGBROOK IL
60440-3455
US

IV. Provider business mailing address

440 QUADRANGLE DR STE K
BOLINGBROOK IL
60440-3455
US

V. Phone/Fax

Practice location:
  • Phone: 630-765-1979
  • Fax:
Mailing address:
  • Phone: 630-765-1979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149031042
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: