Healthcare Provider Details

I. General information

NPI: 1336071083
Provider Name (Legal Business Name): BRANDY ROZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20206 S FRANKFORT SQUARE RD APT B
FRANKFORT IL
60423-8958
US

IV. Provider business mailing address

20206 S FRANKFORT SQUARE RD APT B
FRANKFORT IL
60423-8958
US

V. Phone/Fax

Practice location:
  • Phone: 219-513-8311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-26-538160
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: