| Doctor Name: | JANE SUSANN BRENNEKE |
| NPI Number: | 1013268911 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, LPC |
| License Number: | 2012024498 |
| Business Practice Address: | 309 Garrett St Fredericktown, MO - 636451084 |
| Business Phone Number: | 5732381027 |
| Business Fax Number: | 5736514345 |
| Mailing Address: | 402 S Silver Springs Rd, CAPE GIRARDEAU |
| State: | MO |
| Postal Code: | 637037536 |
| Phone Number: | 5733341100 |
| Fax Number: | 5736514345 |
| NPI Enumeration Date: | 10/02/2012 |
| NPI Last Update Date: | 10/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2012024498 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |