Provider Demographics
NPI:1154948842
Name:BRENNAN, RONNA LYNETTE (LPC-IT)
Entity type:Individual
Prefix:
First Name:RONNA
Middle Name:LYNETTE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 SHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-6919
Mailing Address - Country:US
Mailing Address - Phone:608-213-2222
Mailing Address - Fax:
Practice Address - Street 1:1 1/2 W GENEVA ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-1722
Practice Address - Country:US
Practice Address - Phone:262-723-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4645-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional