Provider Demographics
NPI:1720745797
Name:ENGRAV, BRITTNI LAUREN STILLE
Entity Type:Individual
Prefix:
First Name:BRITTNI
Middle Name:LAUREN STILLE
Last Name:ENGRAV
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 1:708 5TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2339
Mailing Address - Country:US
Mailing Address - Phone:319-895-2220
Mailing Address - Fax:
Practice Address - Street 1:708 5TH ST STE 4
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2339
Practice Address - Country:US
Practice Address - Phone:319-895-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0081581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical