Healthcare Provider Details

I. General information

NPI: 1164886883
Provider Name (Legal Business Name): EMILY BREDLAU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HEALTH SERVICES DR
DEKALB IL
60115-9637
US

IV. Provider business mailing address

1125 DALBIGNE ST
BELVIDERE IL
61008-2520
US

V. Phone/Fax

Practice location:
  • Phone: 815-766-3194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.023161
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: