Individual
BRANDI M LANDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1107 N. BLACKHAWK BLVD, SUITE 8, ROCKTON, IL 61072-1500
(815) 519-1074
(815) 977-5929
Mailing address
1107 N. BLACKHAWK BLVD, SUITE 8, ROCKTON, IL 61072-1500
(815) 519-1074
(815) 977-5929
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
149010571
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL 5794
MEDICARE PTAN
IL
Enumeration date
11/10/2006
Last updated
09/23/2016
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