MEDICARE: MS. CORLISS ANN BREEN

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1578959581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CORLISS ANN BREEN

Provider Business Mailing Address
First Line	:	500 W SILVER SPRING DR
Second Line	:	SUITE 200
City	:	GLENDALE
State	:	WI
Zip	:	53217-5051
Country	:	US
Telephone Number	:	414-847-6253
Fax Number	:	414-501-2361

Provider Business Practice Location Address
First Line	:	500 W SILVER SPRING DR
Second Line	:	SUITE 200
City	:	GLENDALE
State	:	WI
Zip	:	53217-5051
Country	:	US
Telephone Number	:	414-847-6253
Fax Number	:	414-501-2361

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

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	04/07/2015

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