Individual
BRENNA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
2519 N 64TH ST, WAUWATOSA, WI 53213-1405
(414) 379-7446
Mailing address
2519 N 64TH ST, WAUWATOSA, WI 53213-1405
(414) 379-7446
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1015912299
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1015912299
WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION
WI
Enumeration date
10/01/2018
Last updated
10/01/2018
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