Healthcare Provider Details

I. General information

NPI: 1629535141
Provider Name (Legal Business Name): BRIANNA FALK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 E LONGVIEW DR
APPLETON WI
54911-2130
US

IV. Provider business mailing address

626 E LONGVIEW DR
APPLETON WI
54911-2130
US

V. Phone/Fax

Practice location:
  • Phone: 920-215-0107
  • Fax:
Mailing address:
  • Phone: 920-215-0513
  • Fax: 920-253-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12822-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12822-125
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: