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NPI Code Detail

MEDICARE: PATRICIA JEAN BRENNEMAN MA, LP

MEDICARE: PATRICIA JEAN BRENNEMAN MA, LP
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
1103T00000XPsychologistLP 3983MN

General Provider Information

NPI Number : 1902956691
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA JEAN BRENNEMAN MA, LP
Provider Business Mailing Address
First Line : 4324 ALDRICH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55409-1811
Country : US
Telephone Number : 612-823-7539
Fax Number :
Provider Business Practice Location Address
First Line : 4432 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3519
Country : US
Telephone Number : 612-870-2457
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 07/08/2007

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