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General NPI Number Information
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NPI Number | 1720756273
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Entity Type | Individual
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Provider Name | BRITTANY GLEASON
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 1205 S 70TH ST STE 301
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City | WEST ALLIS
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State | WI
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Zip | 53214-3171
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Country | US
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Telephone | 144-752-7884
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Fax |
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Provider Business Mailing Address
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Address Line | 6233 39TH AVE
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City | KENOSHA
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State | WI
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Zip | 53142-7015
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Country | US
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Telephone | 262-654-1004
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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 | 4158-226
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4110-57
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License Number State | WI
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