Provider Demographics
NPI:1316195290
Name:BRATANCH, SHARLA FRANCES
Entity Type:Individual
Prefix:
First Name:SHARLA
Middle Name:FRANCES
Last Name:BRATANCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MASHIE CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1435
Mailing Address - Country:US
Mailing Address - Phone:630-696-5639
Mailing Address - Fax:
Practice Address - Street 1:1979 N MILL ST
Practice Address - Street 2:SUITE # 202
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1200
Practice Address - Country:US
Practice Address - Phone:630-428-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178005306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health