Provider Demographics
NPI:1689056830
Name:ASHENBRENER, BRYANNA KIM (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BRYANNA
Middle Name:KIM
Last Name:ASHENBRENER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:BRYANNA
Other - Middle Name:KIM
Other - Last Name:MERTENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:980 MARITIME DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2962
Mailing Address - Country:US
Mailing Address - Phone:920-905-1020
Mailing Address - Fax:920-905-1020
Practice Address - Street 1:980 MARITIME DR STE 1
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2962
Practice Address - Country:US
Practice Address - Phone:920-905-1020
Practice Address - Fax:920-905-1020
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6280-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1689056830Medicaid