Healthcare Provider Details

I. General information

NPI: 1881188746
Provider Name (Legal Business Name): BRENIQUE BELIN M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 AIRPORT RD
WAUKESHA WI
53188-2461
US

IV. Provider business mailing address

3127 N 86TH ST
MILWAUKEE WI
53222-3710
US

V. Phone/Fax

Practice location:
  • Phone: 262-970-4790
  • Fax:
Mailing address:
  • Phone: 414-699-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: