Healthcare Provider Details

I. General information

NPI: 1922687656
Provider Name (Legal Business Name): BRENNA A CARLSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 E PLANK RD UNIT 3
APPLETON WI
54915-7045
US

IV. Provider business mailing address

2060 E PLANK RD UNIT 3
APPLETON WI
54915-7045
US

V. Phone/Fax

Practice location:
  • Phone: 715-347-3046
  • Fax:
Mailing address:
  • Phone: 715-347-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number425-140
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: