Healthcare Provider Details

I. General information

NPI: 1093637993
Provider Name (Legal Business Name): BRIANA FLETCHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6805 W LAMARSH DR
MAPLETON IL
61547-9309
US

IV. Provider business mailing address

6805 W LAMARSH DR
MAPLETON IL
61547-9309
US

V. Phone/Fax

Practice location:
  • Phone: 309-258-7090
  • Fax:
Mailing address:
  • Phone: 309-532-4528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149016335
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: