Basic Information
| Provider Information | |||||||||
| NPI: | 1497875033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRENDA ANN HUSFELDT PHD LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6547 N AVONDALE AVE | ||||||||
| Address2: | SUITE 001 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606311573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737751622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9933 LAWLER AVE | ||||||||
| Address2: | SUITE 314 | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600773703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737751622 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUSFELDT | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHD LTD | ||||||||
| AuthorizedOfficialTelephone: | 7737751622 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD LTD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.