Healthcare Provider Details

I. General information

NPI: 1831979079
Provider Name (Legal Business Name): BRENDA RUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA RUIZ ARAGON

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S MARION ST
OAK PARK IL
60302-3257
US

IV. Provider business mailing address

6800 S BELL AVE
CHICAGO IL
60636-3137
US

V. Phone/Fax

Practice location:
  • Phone: 312-415-5507
  • Fax:
Mailing address:
  • Phone: 773-987-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: