MEDICARE: BRYNN MADISON WEISS LPC-IT

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	101YM0800X	Mental Health Counselor	8315-226	WI

General Provider Information

NPI Number	:	1912678905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYNN MADISON WEISS LPC-IT

Provider Business Mailing Address
First Line	:	1300 N JACKSON ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2602
Country	:	US
Telephone Number	:	414-390-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 CHEYENNE AVE STE 200
Second Line	:
City	:	GRAFTON
State	:	WI
Zip	:	53024-9323
Country	:	US
Telephone Number	:	414-390-5800
Fax Number	:

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

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	06/26/2025

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