Healthcare Provider Details

I. General information

NPI: 1033042049
Provider Name (Legal Business Name): BRENNA KATHERYN CENTINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 W 102ND ST
BLOOMINGTON MN
55437-2610
US

IV. Provider business mailing address

4551 W 102ND ST
BLOOMINGTON MN
55437-2610
US

V. Phone/Fax

Practice location:
  • Phone: 952-806-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1779
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: