Healthcare Provider Details

I. General information

NPI: 1205772365
Provider Name (Legal Business Name): BREANNA MARIE DAVIES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 E WOODFIELD RD STE 402
SCHAUMBURG IL
60173-4958
US

IV. Provider business mailing address

10902 75TH ST APT 212
KENOSHA WI
53142-8398
US

V. Phone/Fax

Practice location:
  • Phone: 630-473-8129
  • Fax:
Mailing address:
  • Phone: 224-430-3996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.018711
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: