Healthcare Provider Details

I. General information

NPI: 1750296778
Provider Name (Legal Business Name): BRIDGET CLAIRE BRAZIL MUISE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3758 W MCLEAN AVE UNIT 1F
CHICAGO IL
60647-3418
US

IV. Provider business mailing address

3758 W MCLEAN AVE UNIT 1F
CHICAGO IL
60647-3418
US

V. Phone/Fax

Practice location:
  • Phone: 636-634-1180
  • Fax:
Mailing address:
  • Phone: 636-634-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.023332
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: