MEDICARE: ANN ELIZABETH BRUNNER MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	10549-125	WI

General Provider Information

NPI Number	:	1013673573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN ELIZABETH BRUNNER MA, LPC

Provider Business Mailing Address
First Line	:	16655 W BLUEMOUND RD STE 330
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-5935
Country	:	US
Telephone Number	:	262-786-9184
Fax Number	:	262-786-1906

Provider Business Practice Location Address
First Line	:	16655 W BLUEMOUND RD STE 330
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-5935
Country	:	US
Telephone Number	:	262-786-9184
Fax Number	:	262-786-1906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	03/15/2024

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