1043581911 NPI number — MRS. VALERIE ANNE BRENNEMAN LPC

Table of content: MRS. VALERIE ANNE BRENNEMAN LPC (NPI 1043581911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043581911 NPI number — MRS. VALERIE ANNE BRENNEMAN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENNEMAN
Provider First Name:
VALERIE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWISHER
Provider Other First Name:
VALERIE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043581911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 FARMRIDGE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-785-7208
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5745 W. MAPLE RD.
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-862-5110
Provider Business Practice Location Address Fax Number:
844-893-1355
Provider Enumeration Date:
01/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: 6401013071 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0138278 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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