Provider Demographics
NPI:1376590182
Name:BRENNAN, SANDY L (MED MSW LISW)
Entity Type:Individual
Prefix:MS
First Name:SANDY
Middle Name:L
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MED MSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23345 235TH PLACE
Mailing Address - Street 2:
Mailing Address - City:LACONA
Mailing Address - State:IA
Mailing Address - Zip Code:50139
Mailing Address - Country:US
Mailing Address - Phone:515-321-4116
Mailing Address - Fax:
Practice Address - Street 1:505 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240
Practice Address - Country:US
Practice Address - Phone:319-354-6238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA015331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA244633OtherMIDLANDS CHOICE
IA06154OtherWELLMARK BCBS