Healthcare Provider Details

I. General information

NPI: 1780592824
Provider Name (Legal Business Name): BRENDAN WILLIAM SKINNER B.S., M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OAKLAND DR FL 3
KALAMAZOO MI
49008-1282
US

IV. Provider business mailing address

4037 STANDISH ST
KALAMAZOO MI
49008-3125
US

V. Phone/Fax

Practice location:
  • Phone: 269-387-7000
  • Fax:
Mailing address:
  • Phone: 414-595-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6352001264
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: