Provider Demographics
NPI:1386139202
Name:BREIDENBACH, MONIKA (LCPC)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:BREIDENBACH
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 1:200 E CHICAGO AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1756
Mailing Address - Country:US
Mailing Address - Phone:708-406-9792
Mailing Address - Fax:
Practice Address - Street 1:200 E CHICAGO AVE STE 10
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1756
Practice Address - Country:US
Practice Address - Phone:708-406-9792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013455101YM0800X
IL180015711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health