Healthcare Provider Details

I. General information

NPI: 1124942446
Provider Name (Legal Business Name): BREANNE C DALE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E HURON ST UNIT 4B
CHICAGO IL
60611-5244
US

IV. Provider business mailing address

40 E HURON ST UNIT 4B
CHICAGO IL
60611-5244
US

V. Phone/Fax

Practice location:
  • Phone: 866-434-1735
  • Fax:
Mailing address:
  • Phone: 866-434-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.020573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: