Individual
BREANNA L VONCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
436 E LONGVIEW DR STE A, APPLETON, WI 54911-2166
(920) 239-5017
Mailing address
436 E LONGVIEW DR STE A, APPLETON, WI 54911-2166
(920) 239-5017
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7786
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
189107706
—
WI
01
—
443000067
MEDICARE PTAN
WI
01
—
841740049
MEDICARE PTAN
WI
Enumeration date
09/15/2011
Last updated
11/07/2022
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