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General NPI Number Information
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NPI Number | 1992433189
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Entity Type | Individual
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Provider Name | DAVID PETER BRONSVELD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 100 N WAUKEGAN RD STE 204
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1660
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Country | US
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Telephone | 312-298-9562
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N WAUKEGAN RD STE 204
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City | LAKE BLUFF
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State | IL
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Zip | 60044-1660
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Country | US
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Telephone | 312-298-9562
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.018259
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License Number State | IL
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