Healthcare Provider Details

I. General information

NPI: 1598688400
Provider Name (Legal Business Name): BRIANA TODY VITEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST COUNTY HWY B
SHELL LAKE WI
54871
US

IV. Provider business mailing address

61065 STORCK RD
MASON WI
54856-3051
US

V. Phone/Fax

Practice location:
  • Phone: 715-468-2841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: