Provider Demographics
NPI:1700474178
Name:BENTLEY, BRENNA GRACE (CGC)
Entity Type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:GRACE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 YEAGER LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-6652
Mailing Address - Country:US
Mailing Address - Phone:662-404-4267
Mailing Address - Fax:
Practice Address - Street 1:19925 STEVENS CREEK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2384
Practice Address - Country:US
Practice Address - Phone:877-362-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS