Provider Demographics
NPI:1639750912
Name:BRENNEN, AMANDA (LPMT, MT-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BRENNEN
Suffix:
Gender:F
Credentials:LPMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9880 HICKORY FLAT HWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3081
Mailing Address - Country:US
Mailing Address - Phone:770-687-2542
Mailing Address - Fax:
Practice Address - Street 1:9880 HICKORY FLAT HWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3081
Practice Address - Country:US
Practice Address - Phone:770-687-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-18
Last Update Date:2021-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16451225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist