Provider Demographics
NPI:1457980575
Name:BRINN, RENEE VICTORIA (MT-BC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:VICTORIA
Last Name:BRINN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11219 PACKARD AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-2516
Mailing Address - Country:US
Mailing Address - Phone:248-506-9380
Mailing Address - Fax:
Practice Address - Street 1:11219 PACKARD AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2516
Practice Address - Country:US
Practice Address - Phone:248-506-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14771225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist