Provider Demographics
NPI:1548296502
Name:BRANDENBURG, DANA (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 E 28TH ST
Mailing Address - Street 2:UFP SMILEY'S CLINIC
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1394
Mailing Address - Country:US
Mailing Address - Phone:612-333-0770
Mailing Address - Fax:612-333-1986
Practice Address - Street 1:2020 E 28TH ST
Practice Address - Street 2:UFP SMILEY'S CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1394
Practice Address - Country:US
Practice Address - Phone:612-333-0770
Practice Address - Fax:612-333-1986
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4535103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN615T1BROtherBCBS SMILEY'S
MN61-53755OtherUBH
MNA049OtherCHAMPUS
MN1042740OtherPREFERRED ONE
MN175R2BROtherBCBS
MNHP48442OtherHEALTHPARTNERS
MN577460800Medicaid
MN113221OtherUCARE
MN2280059OtherARAZ
MN61-53755OtherUBH