Provider Demographics
NPI:1609925221
Name:NORTHRUP, BRANDI SUZANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:SUZANNE
Last Name:NORTHRUP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:822 N 129TH INFANTRY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3105
Mailing Address - Country:US
Mailing Address - Phone:815-823-8460
Mailing Address - Fax:815-823-8460
Practice Address - Street 1:822 N 129TH INFANTRY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3105
Practice Address - Country:US
Practice Address - Phone:815-823-8460
Practice Address - Fax:815-823-8460
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.011327101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health