Provider Demographics
NPI:1225407224
Name:THOMAS, BRENDA (LADC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:STEIVANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2337 DELONG RD
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020-7300
Mailing Address - Country:US
Mailing Address - Phone:715-529-5292
Mailing Address - Fax:651-401-2822
Practice Address - Street 1:2337 DELONG RD
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020-7300
Practice Address - Country:US
Practice Address - Phone:715-529-5292
Practice Address - Fax:651-401-2822
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301064101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)