MEDICARE: BRIA GRANT BRIA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	15555-130	WI

General Provider Information

NPI Number	:	1952697146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIA GRANT BRIA

Provider Business Mailing Address
First Line	:	1433 N WATER ST STE 400
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2603
Country	:	US
Telephone Number	:	414-793-8531
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 N WATER ST STE 400
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-2603
Country	:	US
Telephone Number	:	414-793-8531
Fax Number	:

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

Provider Enumeration Date	:	06/25/2011
Last Update Date	:	04/19/2026

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