Provider Demographics
NPI:1902801061
Name:HEALY, BRENNA P (MA)
Entity type:Individual
Prefix:MS
First Name:BRENNA
Middle Name:P
Last Name:HEALY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ASBURY RD
Mailing Address - Street 2:STE 5
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3091
Mailing Address - Country:US
Mailing Address - Phone:563-556-1225
Mailing Address - Fax:563-556-0713
Practice Address - Street 1:2100 ASBURY RD
Practice Address - Street 2:STE 5
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3091
Practice Address - Country:US
Practice Address - Phone:563-556-1225
Practice Address - Fax:563-556-0713
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA591103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling