Provider Demographics
NPI:1770635419
Name:BRENNER, ELLEN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:M
Last Name:BRENNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2839
Mailing Address - Country:US
Mailing Address - Phone:509-534-9407
Mailing Address - Fax:509-536-2804
Practice Address - Street 1:815 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2839
Practice Address - Country:US
Practice Address - Phone:509-534-9407
Practice Address - Fax:509-536-2804
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health