Provider Demographics
NPI:1609483692
Name:NELSON, BREANN L (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:BREANN
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3829 WOODLEY RD STE B6
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1174
Mailing Address - Country:US
Mailing Address - Phone:419-690-4544
Mailing Address - Fax:
Practice Address - Street 1:3829 WOODLEY RD STE B6
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1174
Practice Address - Country:US
Practice Address - Phone:419-690-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2001524-TRNE101YM0800X
OHS.2207382104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health