Healthcare Provider Details

I. General information

NPI: 1770414344
Provider Name (Legal Business Name): BRIGHT STEPS THERAPY NETWORK IL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 N CLARK ST
CHICAGO IL
60657-5775
US

IV. Provider business mailing address

2828 N CLARK ST
CHICAGO IL
60657-5775
US

V. Phone/Fax

Practice location:
  • Phone: 516-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE FAUQUIER
Title or Position: MANAGING PARTNER
Credential: SLP
Phone: 847-977-9853