Healthcare Provider Details

I. General information

NPI: 1952212730
Provider Name (Legal Business Name): BRIANNA LYNN MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N51W15819 FAIR OAK PKWY
MENOMONEE FALLS WI
53051-6655
US

IV. Provider business mailing address

N51W15819 FAIR OAK PKWY
MENOMONEE FALLS WI
53051-6655
US

V. Phone/Fax

Practice location:
  • Phone: 715-451-2041
  • Fax:
Mailing address:
  • Phone: 715-451-2041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11812-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: