Provider Demographics
NPI:1215130018
Name:BRETTHAUER, PAMELA ANN (LCPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:BRETTHAUER
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 1:329 KENLOCH AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1771
Mailing Address - Country:US
Mailing Address - Phone:847-347-7367
Mailing Address - Fax:224-513-4700
Practice Address - Street 1:505 E HAWLEY ST
Practice Address - Street 2:SUITE 140
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2494
Practice Address - Country:US
Practice Address - Phone:847-347-7367
Practice Address - Fax:224-513-4700
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional