1487723367 NPI number — DR. BRENDA ANN HUSFELDT PHD

Table of content: DR. BRENDA ANN HUSFELDT PHD (NPI 1487723367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487723367 NPI number — DR. BRENDA ANN HUSFELDT PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSFELDT
Provider First Name:
BRENDA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487723367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 617
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-502-3706
Provider Business Mailing Address Fax Number:
847-919-3919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9933 LAWLER AVE
Provider Second Line Business Practice Location Address:
SUITE 314
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-502-3706
Provider Business Practice Location Address Fax Number:
847-919-3919
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  LP2966 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 37609 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".




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