Provider Demographics
NPI:1386727386
Name:WINTERS, BRENDA K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:K
Last Name:WINTERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 AMANDA CT
Mailing Address - Street 2:
Mailing Address - City:ARTHUR
Mailing Address - State:IL
Mailing Address - Zip Code:61911
Mailing Address - Country:US
Mailing Address - Phone:217-543-3014
Mailing Address - Fax:
Practice Address - Street 1:506 N DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:VILLA GROVE
Practice Address - State:IL
Practice Address - Zip Code:61956-1031
Practice Address - Country:US
Practice Address - Phone:352-223-2689
Practice Address - Fax:352-343-8831
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical