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General NPI Number Information
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NPI Number | 1366119174
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Entity Type | Individual
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Provider Name | RYAN KELSEY BRANDT LPC, ATR-P
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Gender | Female
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Dates
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Enumeration Date | 08/28/2021
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 1440 RENAISSANCE DR STE 320
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City | PARK RIDGE
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State | IL
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Zip | 60068-1471
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Country | US
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Telephone | 847-759-9110
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Fax | 847-759-9440
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Provider Business Mailing Address
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Address Line | 2733 W BELDEN AVE UNIT 1104
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City | CHICAGO
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State | IL
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Zip | 60647-2464
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Country | US
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Telephone | 281-541-6689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 178.017836
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License Number State | IL
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