Healthcare Provider Details

I. General information

NPI: 1063234540
Provider Name (Legal Business Name): TORI BRUEGGERT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CRYSTAL LN
DIAMOND IL
60416-7086
US

IV. Provider business mailing address

1055 CRYSTAL LN
DIAMOND IL
60416-7086
US

V. Phone/Fax

Practice location:
  • Phone: 815-529-7267
  • Fax:
Mailing address:
  • Phone: 815-529-7267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA BRUEGGERT
Title or Position: OWNER/NURSE PRACTITIONER
Credential: APRN
Phone: 815-529-7267