Healthcare Provider Details

I. General information

NPI: 1336658434
Provider Name (Legal Business Name): BRIGITTE L OETTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS BRIGITTE LYNN MUTZ

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6106 PHEASANT RIDGE DR
PLAINFIELD IL
60586
US

IV. Provider business mailing address

590 BELMONT DR
ROMEOVILLE IL
60446-1400
US

V. Phone/Fax

Practice location:
  • Phone: 815-514-3067
  • Fax:
Mailing address:
  • Phone: 815-372-6515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014651
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: