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NPI Code Detail

MEDICARE: BREANNA WANDRYCH LMSW-T

MEDICARE: BREANNA WANDRYCH LMSW-T
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
1101Y00000XCounselorLMSW-7937TAZ

General Provider Information

NPI Number : 1518643345
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA WANDRYCH LMSW-T
Provider Business Mailing Address
First Line : 10610 S 54TH LN
Second Line :
City : LAVEEN
State : AZ
Zip : 85339-5421
Country : US
Telephone Number : 480-202-6271
Fax Number :
Provider Business Practice Location Address
First Line : 333 W ROOSEVELT ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85003-1324
Country : US
Telephone Number : 623-252-0223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2023
Last Update Date : 06/26/2023

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Directions to “ BREANNA WANDRYCH LMSW-T” Practice Location

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