Provider Demographics
NPI:1285332205
Name:WESTHOLM, BRANDON DOUGLAS
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:DOUGLAS
Last Name:WESTHOLM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E LESSARD ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-3026
Mailing Address - Country:US
Mailing Address - Phone:608-218-4403
Mailing Address - Fax:
Practice Address - Street 1:1501 E LESSARD ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-3026
Practice Address - Country:US
Practice Address - Phone:715-642-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16542225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist