Provider Demographics
NPI:1942708789
Name:WAUPEKENAY, BRANDON (2789-226 LPC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:WAUPEKENAY
Suffix:
Gender:M
Credentials:2789-226 LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 1/2 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-1945
Mailing Address - Country:US
Mailing Address - Phone:715-304-6057
Mailing Address - Fax:
Practice Address - Street 1:N2150 KESAEHKAHTEK RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:WI
Practice Address - Zip Code:54128-9602
Practice Address - Country:US
Practice Address - Phone:715-799-3835
Practice Address - Fax:715-799-5056
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2789226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional