Provider Demographics
NPI:1235928631
Name:BAILEY, BRENDA (PHD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:REMINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34700 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4500
Mailing Address - Country:US
Mailing Address - Phone:800-767-4411
Mailing Address - Fax:800-767-4411
Practice Address - Street 1:2424 S 102ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-2106
Practice Address - Country:US
Practice Address - Phone:800-767-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3515103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist