Provider Demographics
NPI:1992591630
Name:BRANDENBURG, ABIGAIL K
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:K
Last Name:BRANDENBURG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:K
Other - Last Name:BENVENUTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W57N969 OXFORD CT
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 N 113TH ST STE 200
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3209
Practice Address - Country:US
Practice Address - Phone:262-432-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent