Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2646-057 | WI |
NPI | 1093998593 |
---|---|
Provider Name | Laura G. Brewer |
First Address | Brookfield, WI 53045-6102 |
Second Address | Port Washington, WI 53074-1939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2007 |
Last Update Date | 07/12/2007 |