Healthcare Provider Details

I. General information

NPI: 1003683301
Provider Name (Legal Business Name): BRIDGETTE RATCLIFFE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8695 ARCHER AVE
WILLOW SPRINGS IL
60480-1260
US

IV. Provider business mailing address

9443 COMMONS DR
HICKORY HILLS IL
60457-1859
US

V. Phone/Fax

Practice location:
  • Phone: 708-381-0897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178017751
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: