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NPI Code Detail

MEDICARE: LAURA BRUSCHUK LCPC

MEDICARE:   LAURA  BRUSCHUK  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
1101YM0800XMental Health Counselor180.007793IL

General Provider Information

NPI Number : 1740658822
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA BRUSCHUK LCPC
Provider Business Mailing Address
First Line : 1448 N MILWAUKEE AVE # 205
Second Line :
City : CHICAGO
State : IL
Zip : 60622-9225
Country : US
Telephone Number : 312-476-9064
Fax Number : 630-839-8697
Provider Business Practice Location Address
First Line : 1754 N WASHINGTON ST STE 120
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-1462
Country : US
Telephone Number : 312-476-9064
Fax Number : 630-839-8697
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2015
Last Update Date : 09/08/2015

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Directions to “ LAURA BRUSCHUK LCPC” Practice Location

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