Individual
MR. BRUCE B DANNENBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
110 E MAIN ST, SUITE 309, OTTAWA, IL 61350-2900
(815) 434-2118
(815) 434-5253
Mailing address
401 W MOORE ST, SUITE 309, OTTAWA, IL 61350-3855
(815) 433-3662
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149004294
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05007410
PIN
IL
Enumeration date
03/29/2007
Last updated
07/09/2007
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