Healthcare Provider Details

I. General information

NPI: 1356149769
Provider Name (Legal Business Name): IZABELLA BEBENEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 W POLK ST
CHICAGO IL
60605-2000
US

IV. Provider business mailing address

1621 SOUTHRIDGE TRL
ALGONQUIN IL
60102-6601
US

V. Phone/Fax

Practice location:
  • Phone: 312-667-3884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.019841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: