Provider Demographics
NPI:1609493303
Name:MYSLIWIEC, BRANDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:
Last Name:MYSLIWIEC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:DINGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6543 STAFFORD TRCE
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9176
Mailing Address - Country:US
Mailing Address - Phone:574-286-1573
Mailing Address - Fax:
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043363B103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical