Healthcare Provider Details

I. General information

NPI: 1124945837
Provider Name (Legal Business Name): BRIANNA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S PROSPECT AVE FL 3
PARK RIDGE IL
60068-4037
US

IV. Provider business mailing address

5528 CAMBRIDGE WAY
HANOVER PARK IL
60133-3674
US

V. Phone/Fax

Practice location:
  • Phone: 847-379-5477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150113731
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: