MEDICARE: BRADLEY W BRUCKER

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	178.022866	IL

General Provider Information

NPI Number	:	1487511069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY W BRUCKER

Provider Business Mailing Address
First Line	:	3331 W BERTEAU AVE APT 2A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2346
Country	:	US
Telephone Number	:	312-218-0630
Fax Number	:

Provider Business Practice Location Address
First Line	:	3331 W BERTEAU AVE APT 2A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2346
Country	:	US
Telephone Number	:	312-218-0630
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	03/17/2026

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Directions to “ BRADLEY W BRUCKER ” Practice Location

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