MEDICARE: BRENNA GREENFIELD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1447608187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA GREENFIELD

Provider Business Mailing Address
First Line	:	1035 UNIVERSITY DR
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55812-3031
Country	:	US
Telephone Number	:	218-726-7721
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 UNIVERSITY DR
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55812-3031
Country	:	US
Telephone Number	:	218-726-7721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	06/02/2016

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Directions to “ BRENNA GREENFIELD ” Practice Location

Language	Start Address	Practice Location

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