Healthcare Provider Details

I. General information

NPI: 1295656742
Provider Name (Legal Business Name): JENNA KITTLER BREWER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5000
US

IV. Provider business mailing address

625 LAKEVIEW DR
MCCOOK LAKE SD
57049-4092
US

V. Phone/Fax

Practice location:
  • Phone: 605-232-3332
  • Fax:
Mailing address:
  • Phone: 712-281-0279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: