MEDICARE: BRIDGET CASEY BRENTON LISW

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	1041C0700X	Clinical Social Worker	06207	IA

General Provider Information

NPI Number	:	1366847964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET CASEY BRENTON LISW

Provider Business Mailing Address
First Line	:	1434 OAKLAWN AVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-5647
Country	:	US
Telephone Number	:	319-331-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 STURGIS CORNER DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-5617
Country	:	US
Telephone Number	:	319-331-1611
Fax Number	:

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

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	02/22/2015

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