Provider Demographics
NPI:1568107662
Name:MITCHELL, BREANNA MARIE (GC)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:
Credentials:GC
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:TEN EYCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:733 W CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6101
Mailing Address - Country:US
Mailing Address - Phone:715-464-8105
Mailing Address - Fax:
Practice Address - Street 1:733 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6101
Practice Address - Country:US
Practice Address - Phone:715-464-8105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1100-61170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS