Provider Demographics
NPI:1124486733
Name:NEMITZ, BRENDA JO (LPC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JO
Last Name:NEMITZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:JO
Other - Last Name:LANHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:2224 SETTER DR
Mailing Address - Street 2:
Mailing Address - City:KRONENWETTER
Mailing Address - State:WI
Mailing Address - Zip Code:54455-7278
Mailing Address - Country:US
Mailing Address - Phone:715-551-4137
Mailing Address - Fax:
Practice Address - Street 1:3704 WESTON AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5242
Practice Address - Country:US
Practice Address - Phone:715-298-6364
Practice Address - Fax:715-298-6365
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100054852Medicaid