Person, Bruce

Person, Bruce is an individual health care provider with primary practice located at 1752 Windsor Rd Ste 203 , Loves Park IL 61111-4276. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Person, Bruce can be contacted via phone (815) 986-1113.

Contact Information

Primary practice address
1752 Windsor Rd Ste 203 Loves Park IL 61111-4276
Phone: (815) 986-1113
Fax: (815) 986-1119
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 149-007548 Illinois

Profile Details

NPI number 1629341219
LBN Legal business name Person, Bruce
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2012
Last updated Feb 14th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629341219 NPPES
Illinois Other 149-007548 STATE OF ILLINOIS LICENSE

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