Healthcare Provider Details

I. General information

NPI: 1033027933
Provider Name (Legal Business Name): OPEN BRIDGE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 W NORWOOD ST # 2
CHICAGO IL
60660-2519
US

IV. Provider business mailing address

1262 W NORWOOD ST # 2
CHICAGO IL
60660-2519
US

V. Phone/Fax

Practice location:
  • Phone: 773-636-6453
  • Fax:
Mailing address:
  • Phone: 773-636-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SPENCER
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 773-636-6453