Provider Demographics
NPI:1528697364
Name:BREKKE, ANN (LCPC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BREKKE
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 1:12145 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-1387
Mailing Address - Country:US
Mailing Address - Phone:773-572-5389
Mailing Address - Fax:773-432-6887
Practice Address - Street 1:12145 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-1387
Practice Address - Country:US
Practice Address - Phone:773-572-5389
Practice Address - Fax:773-432-6887
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6014101YA0400X
IL180003884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)