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General NPI Number Information
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NPI Number | 1174339576
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Entity Type | Individual
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Provider Name | TAMMIE BRENTON LSW
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Gender | Female
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 1535 FIRST ST
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City | SANDUSKY
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State | OH
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Zip | 44870-3901
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Country | US
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Telephone | 419-357-0933
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Fax |
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Provider Business Mailing Address
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Address Line | 3219 E STONEWAY DR
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City | SANDUSKY
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State | OH
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Zip | 44870-6917
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Country | US
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Telephone | 419-239-6041
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2411705
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License Number State | OH
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