Healthcare Provider Details

I. General information

NPI: 1669544656
Provider Name (Legal Business Name): PATRICIA A. BARDENETT L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N WABASH AVE SUITE 1804
CHICAGO IL
60602-1903
US

IV. Provider business mailing address

1339 N DEARBORN ST #8C
CHICAGO IL
60610-2070
US

V. Phone/Fax

Practice location:
  • Phone: 312-201-9002
  • Fax:
Mailing address:
  • Phone: 312-988-9627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: