Provider Demographics
NPI:1609951169
Name:BRZESZKIEWICZ, ANN M (LCPC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:BRZESZKIEWICZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MOONEY DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914
Mailing Address - Country:US
Mailing Address - Phone:815-933-7887
Mailing Address - Fax:815-933-7870
Practice Address - Street 1:110 MOONEY DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:815-933-7887
Practice Address - Fax:815-933-7870
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional