Healthcare Provider Details

I. General information

NPI: 1710891320
Provider Name (Legal Business Name): BREANNA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 5TH AVE STE 109
NAPERVILLE IL
60563-3173
US

IV. Provider business mailing address

880 N MILWAUKEE AVE APT 5S
CHICAGO IL
60642-4306
US

V. Phone/Fax

Practice location:
  • Phone: 331-457-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022581
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: