MEDICARE: KRISTEN A BREESE M.S., 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	101YP2500X	Professional Counselor	180.006873	IL

General Provider Information

NPI Number	:	1497957930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN A BREESE M.S., LCPC

Provider Business Mailing Address
First Line	:	454 S WRIGHT ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5447
Country	:	US
Telephone Number	:	630-476-1785
Fax Number	:

Provider Business Practice Location Address
First Line	:	1979 N MILL ST
Second Line	:	SUITE 202
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-1200
Country	:	US
Telephone Number	:	630-281-2496
Fax Number	:	630-839-9138

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	05/23/2011

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