Provider Demographics
NPI:1891141289
Name:WEINGARTZ, BRENDA (MA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:WEINGARTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 HAWTHORN DR
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-8032
Mailing Address - Country:US
Mailing Address - Phone:810-338-2927
Mailing Address - Fax:
Practice Address - Street 1:51 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1244
Practice Address - Country:US
Practice Address - Phone:810-689-4846
Practice Address - Fax:810-958-1430
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009066101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor