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General NPI Number Information
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NPI Number | 1700295961
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Entity Type | Individual
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Provider Name | JIM BRUNETTI
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Gender | Male
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 03/01/2019
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Provider Practice Location Address
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Address Line | 2 AMERICAN WAY
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City | ELGIN
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State | IL
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Zip | 60120-4341
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Country | US
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Telephone | 847-742-3545
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Fax |
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Provider Business Mailing Address
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Address Line | 721 S QUENTIN RD
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City | PALATINE
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State | IL
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Zip | 60067-6778
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Country | US
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Telephone | 847-485-3073
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 180.010988
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License Number State | IL
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