MEDICARE: BRENNA LEE

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	103K00000X	Behavior Analyst	1-21-51277	OH

General Provider Information

NPI Number	:	1699215251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA LEE

Provider Business Mailing Address
First Line	:	DEPT LA 22763
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91185-2763
Country	:	US
Telephone Number	:	866-523-4268
Fax Number	:

Provider Business Practice Location Address
First Line	:	DEPT LA 22763
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91185-1990
Country	:	US
Telephone Number	:	866-523-4268
Fax Number	:

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

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	06/15/2022

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Directions to “ BRENNA LEE ” Practice Location

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