=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467067546
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRYNN WIESSNER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2020
-----------------------------------------------------
Last Update Date | 02/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11892 HILLTOP RD
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80134-6019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-817-6531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17478 E RICE CIR UNIT C
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80015-2793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-270-7917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 0009922918
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------