Provider Demographics
NPI:1982221487
Name:BRESKE, DOROTHY
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:
Last Name:BRESKE
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 1:2669 CALIENDO CIR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-4013
Mailing Address - Country:US
Mailing Address - Phone:847-293-7510
Mailing Address - Fax:
Practice Address - Street 1:2669 CALIENDO CIR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-4013
Practice Address - Country:US
Practice Address - Phone:847-293-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician