Healthcare Provider Details

I. General information

NPI: 1912678905
Provider Name (Legal Business Name): BRYNN MADISON WEISS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 CHEYENNE AVE STE 200
GRAFTON WI
53024-9323
US

IV. Provider business mailing address

1245 CHEYENNE AVE STE 200
GRAFTON WI
53024-9323
US

V. Phone/Fax

Practice location:
  • Phone: 414-390-5800
  • Fax:
Mailing address:
  • Phone: 715-842-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12671-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: