Healthcare Provider Details

I. General information

NPI: 1740499938
Provider Name (Legal Business Name): LINDA A BRUGGEMANN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5547 N RAVENSWOOD AVE
CHICAGO IL
60640-1125
US

IV. Provider business mailing address

2645 W GREENLEAF AVE APT. 3W
CHICAGO IL
60645-3264
US

V. Phone/Fax

Practice location:
  • Phone: 773-506-3201
  • Fax: 773-769-1476
Mailing address:
  • Phone: 773-274-8075
  • Fax: 773-388-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: