Provider Demographics
NPI:1922015734
Name:BERTRAND, PATTY (PATRICIA) J (LCPC, RN, CADC)
Entity Type:Individual
Prefix:MRS
First Name:PATTY (PATRICIA)
Middle Name:J
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:LCPC, RN, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W STATE ST
Mailing Address - Street 2:#111
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 W STATE ST
Practice Address - Street 2:#111
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2080
Practice Address - Country:US
Practice Address - Phone:630-927-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004532117OtherBLUE CROSS BLUE SHIELD PP