Healthcare Provider Details

I. General information

NPI: 1457619009
Provider Name (Legal Business Name): BRITTANY ANN NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 BRUCE LN
MOUNT MORRIS IL
61054-1630
US

IV. Provider business mailing address

408 BRUCE LN
MOUNT MORRIS IL
61054-1630
US

V. Phone/Fax

Practice location:
  • Phone: 815-973-4939
  • Fax:
Mailing address:
  • Phone: 815-973-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: