Provider Demographics
NPI:1053057042
Name:REIDSEMA, BRITTANY ANN (LSW)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ANN
Last Name:REIDSEMA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W WASHINGTON ST STE 218
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8232
Mailing Address - Country:US
Mailing Address - Phone:815-290-9989
Mailing Address - Fax:
Practice Address - Street 1:123 W WASHINGTON ST STE 218
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8232
Practice Address - Country:US
Practice Address - Phone:815-290-9989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1501077451041S0200X, 104100000X
IL149.0285971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker