Provider Demographics
NPI:1962410092
Name:HUNTER, BRENDA BEVERLY (MA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:BEVERLY
Last Name:HUNTER
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 1:2831 RIVA RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-9549
Mailing Address - Country:US
Mailing Address - Phone:608-630-5346
Mailing Address - Fax:
Practice Address - Street 1:2831 RIVA RIDGE CIR
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-9549
Practice Address - Country:US
Practice Address - Phone:608-630-5346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4164-125101YP2500X
IL180003943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional