Provider Demographics
NPI:1902969496
Name:GRULKE, BRENDA J (LPC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:GRULKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008
Mailing Address - Country:US
Mailing Address - Phone:262-825-3501
Mailing Address - Fax:
Practice Address - Street 1:740 N PLANKINTON AVE
Practice Address - Street 2:SUITE 334
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-2403
Practice Address - Country:US
Practice Address - Phone:414-271-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5070-125101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional