Provider Demographics
NPI:1740499938
Name:BRUGGEMANN, LINDA A (LPC)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:A
Last Name:BRUGGEMANN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 W GREENLEAF AVE
Mailing Address - Street 2:APT. 3W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-3264
Mailing Address - Country:US
Mailing Address - Phone:773-274-8075
Mailing Address - Fax:773-388-5088
Practice Address - Street 1:5547 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1125
Practice Address - Country:US
Practice Address - Phone:773-506-3201
Practice Address - Fax:773-769-1476
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
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