Provider Demographics
NPI:1992433189
Name:BRONSVELD, DAVID PETER
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PETER
Last Name:BRONSVELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 S SIR GALAHAD LN APT 2A
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-5137
Mailing Address - Country:US
Mailing Address - Phone:312-536-3221
Mailing Address - Fax:
Practice Address - Street 1:3633 W LAKE AVE STE 300
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5803
Practice Address - Country:US
Practice Address - Phone:847-699-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018259101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional