Provider Demographics
NPI:1841039641
Name:BRANDT, ANNETTE J (CRC, LPC)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:J
Last Name:BRANDT
Suffix:
Gender:F
Credentials:CRC, LPC
Other - Prefix:MISS
Other - First Name:ANNETTE
Other - Middle Name:J
Other - Last Name:TALANIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6226 N MOZART ST # 3S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1638
Mailing Address - Country:US
Mailing Address - Phone:630-673-5485
Mailing Address - Fax:
Practice Address - Street 1:5101 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5916
Practice Address - Country:US
Practice Address - Phone:847-802-8992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178019709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional