Healthcare Provider Details

I. General information

NPI: 1407750334
Provider Name (Legal Business Name): BRESHEY PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6253 VIRGINIA LN
MATTESON IL
60443-2075
US

IV. Provider business mailing address

6253 VIRGINIA LN
MATTESON IL
60443-2075
US

V. Phone/Fax

Practice location:
  • Phone: 708-728-5044
  • Fax:
Mailing address:
  • Phone: 708-728-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-234220
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: