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General NPI Number Information
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NPI Number | 1386700037
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Entity Type | Organization
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Legal Business Name | PAUL BRENNAN
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1501 AIRPORT RD
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City | WAUKESHA
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State | WI
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Zip | 53188-2461
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Country | US
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Telephone | 262-548-7992
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 AIRPORT RD
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City | WAUKESHA
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State | WI
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Zip | 53188-2461
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Country | US
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Telephone | 262-548-7992
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Fax |
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Authorized Official
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Title or Position | SR. MENTAL HEALTH COUNSELOR
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Name | MR. PAUL C. BRENNAN
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Credential | BA
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Telephone | 262-548-7992
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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 | 5700120
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License Number State | WI
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