Provider Demographics
NPI:1578105508
Name:PATTON, BRIANA C
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:C
Last Name:PATTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 N LOVERS LANE RD APT 235
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3030
Mailing Address - Country:US
Mailing Address - Phone:414-813-0358
Mailing Address - Fax:
Practice Address - Street 1:5320 N LOVERS LANE RD APT 235
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3030
Practice Address - Country:US
Practice Address - Phone:414-813-0358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131677-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker