Individual
MRS. BRENNA A. KOEDAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, IADC
Contact information
Practice address
201 E 11TH ST, SPENCER, IA 51301-4436
(800) 242-5101
Mailing address
201 E 11TH ST, SPENCER, IA 51301-4436
(800) 242-5101
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
05041
IA
101YM0800X
Mental Health Counselor
001530
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011650
—
IA
Enumeration date
09/19/2012
Last updated
09/19/2012
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