Provider Demographics
NPI:1740658822
Name:BRUSCHUK, LAURA (LCPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BRUSCHUK
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 1:1448 N MILWAUKEE AVE # 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-9225
Mailing Address - Country:US
Mailing Address - Phone:312-476-9064
Mailing Address - Fax:630-839-8697
Practice Address - Street 1:1754 N WASHINGTON ST STE 120
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1462
Practice Address - Country:US
Practice Address - Phone:312-476-9064
Practice Address - Fax:630-839-8697
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health