Provider Demographics
NPI:1902061989
Name:TETZLAFF, BRANDIE LEIGH (MSSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:LEIGH
Last Name:TETZLAFF
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 ELM GROVE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2528
Mailing Address - Country:US
Mailing Address - Phone:262-719-2975
Mailing Address - Fax:
Practice Address - Street 1:890 ELM GROVE RD STE 203
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2528
Practice Address - Country:US
Practice Address - Phone:262-719-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7139-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical