Provider Demographics
NPI:1497875033
Name:BRENDA ANN HUSFELDT PHD LTD
Entity Type:Organization
Organization Name:BRENDA ANN HUSFELDT PHD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD LTD
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUSFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LTD
Authorized Official - Phone:773-775-1622
Mailing Address - Street 1:6547 N AVONDALE AVE
Mailing Address - Street 2:SUITE 001
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1573
Mailing Address - Country:US
Mailing Address - Phone:773-775-1622
Mailing Address - Fax:
Practice Address - Street 1:9933 LAWLER AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3703
Practice Address - Country:US
Practice Address - Phone:773-775-1622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K21694Medicare UPIN
IL212431Medicare ID - Type Unspecified