Healthcare Provider Details

I. General information

NPI: 1497957930
Provider Name (Legal Business Name): KRISTEN A BREESE M.S., LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1979 N MILL ST SUITE 202
NAPERVILLE IL
60563-1200
US

IV. Provider business mailing address

454 S WRIGHT ST
NAPERVILLE IL
60540-5447
US

V. Phone/Fax

Practice location:
  • Phone: 630-281-2496
  • Fax: 630-839-9138
Mailing address:
  • Phone: 630-476-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.006873
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: