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General NPI Number Information
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NPI Number | 1013268911
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Entity Type | Individual
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Provider Name | JANE SUSANN BRENNEKE MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 223 MAIN ST STE B
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City | FESTUS
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State | MO
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Zip | 63028-1952
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Country | US
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Telephone | 636-249-9993
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Fax |
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Provider Business Mailing Address
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Address Line | 9928 THURMAN OAKS RD
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City | VALLES MINES
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State | MO
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Zip | 63087-1324
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Country | US
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Telephone | 636-249-9993
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Fax | 636-243-3903
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2012024498
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License Number State | MO
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