Provider Demographics
NPI:1992315584
Name:QUINN, BRIANNA L (LCSW)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:L
Last Name:QUINN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:L
Other - Last Name:KIRSCHBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:117 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1168
Mailing Address - Country:US
Mailing Address - Phone:608-553-1211
Mailing Address - Fax:
Practice Address - Street 1:101 E FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1749
Practice Address - Country:US
Practice Address - Phone:608-835-5050
Practice Address - Fax:608-835-5010
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1320681211041C0700X
WI111571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100132522Medicaid