Healthcare Provider Details

I. General information

NPI: 1144149519
Provider Name (Legal Business Name): VICTORIA LYNN HUENERBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 RIVERLANE DR
BRADLEY IL
60915-1947
US

IV. Provider business mailing address

598 SPRING PARK LOOP
BOURBONNAIS IL
60914-4968
US

V. Phone/Fax

Practice location:
  • Phone: 815-671-7092
  • Fax:
Mailing address:
  • Phone: 815-671-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: