Provider Demographics
NPI:1700809191
Name:STENNETT-BREWER, LINDA J
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:J
Last Name:STENNETT-BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:STENNETT-BREWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEAP, LCPC
Mailing Address - Street 1:345 E ASH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6137
Mailing Address - Country:US
Mailing Address - Phone:217-872-1003
Mailing Address - Fax:217-233-4150
Practice Address - Street 1:345 E ASH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6137
Practice Address - Country:US
Practice Address - Phone:217-872-1003
Practice Address - Fax:217-233-4150
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1023171006OtherA&E BEHAVIORAL HEALTHCARE
IL200908Medicare ID - Type Unspecified