Provider Demographics
NPI:1922628619
Name:BRIERE, ASHLYN BROOKE
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:BROOKE
Last Name:BRIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 N 98TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2412
Mailing Address - Country:US
Mailing Address - Phone:262-364-9942
Mailing Address - Fax:
Practice Address - Street 1:7358 N LINCOLN AVE STE 160
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1797
Practice Address - Country:US
Practice Address - Phone:847-983-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6680225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist