Provider Demographics
NPI:1578959581
Name:BREEN, CORLISS ANN
Entity Type:Individual
Prefix:MS
First Name:CORLISS
Middle Name:ANN
Last Name:BREEN
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 1:500 W SILVER SPRING DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5051
Mailing Address - Country:US
Mailing Address - Phone:414-847-6253
Mailing Address - Fax:414-501-2361
Practice Address - Street 1:500 W SILVER SPRING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5051
Practice Address - Country:US
Practice Address - Phone:414-847-6253
Practice Address - Fax:414-501-2361
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor