Healthcare Provider Details

I. General information

NPI: 1578338083
Provider Name (Legal Business Name): BRITTANY JEAN DANES SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. BRITTANY JEAN STEVENS

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 LAX CHAPEL RD
KIEL WI
53042-3954
US

IV. Provider business mailing address

PO BOX 347
KIEL WI
53042-0347
US

V. Phone/Fax

Practice location:
  • Phone: 920-286-4488
  • Fax: 920-894-1373
Mailing address:
  • Phone: 920-894-1374
  • Fax: 920-894-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20364130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: