Basic Information
| Provider Information | |||||||||
| NPI: | 1669650099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRENNER | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 EL CERRITO PLZ | ||||||||
| Address2: | |||||||||
| City: | EL CERRITO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945304002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105263824 | ||||||||
| FaxNumber: | 6303035385 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 EL CERRITO PLZ | ||||||||
| Address2: | |||||||||
| City: | EL CERRITO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945304002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105263824 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2008 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA3953 | CA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.