MEDICARE: MONIKA BREIDENBACH LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	178013455	IL
2	101YM0800X	Mental Health Counselor	180015711	IL

General Provider Information

NPI Number	:	1386139202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIKA BREIDENBACH LCPC

Provider Business Mailing Address
First Line	:	200 E CHICAGO AVE STE 10
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-1756
Country	:	US
Telephone Number	:	708-406-9792
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E CHICAGO AVE STE 10
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-1756
Country	:	US
Telephone Number	:	708-406-9792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	04/09/2024

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