Provider Demographics
NPI:1487723367
Name:HUSFELDT, BRENDA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:ANN
Last Name:HUSFELDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065
Mailing Address - Country:US
Mailing Address - Phone:847-502-3706
Mailing Address - Fax:847-919-3919
Practice Address - Street 1:9933 LAWLER AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-502-3706
Practice Address - Fax:847-919-3919
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2966103T00000X
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
37609OtherMAGELLAN
37609OtherMAGELLAN
212431Medicare ID - Type Unspecified