Active NPI
Ann Bruckelmeyer, LCSW, CADC
- Professional Counselor
- Glen Ellyn, IL
National Provider Identifier
1508974478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 149009205
- Practice address
- 195 Tanglewood Dr
Glen Ellyn, IL 60137-7843 - Phone
- (630) 545-0795
- Fax
- (630) 545-0781
- NPI assigned
- Aug 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 149009205 | IL | Primary |
Addresses
Primary practice location
195 Tanglewood Dr
Glen Ellyn, IL 60137-7843
Mailing address
195 Tanglewood Dr
Glen Ellyn, IL 60137-7843
Phone (630) 545-0795
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149009205 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508974478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "195 TANGLEWOOD DR",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601377843",
"telephone_number": "630-545-0795",
"fax_number": "630-545-0781"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "195 TANGLEWOOD DR",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601377843",
"telephone_number": "630-545-0795",
"fax_number": "630-545-0781"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCKELMEYER",
"first_name": "ANN",
"credential": "LCSW, CADC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "149009205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Ellyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.