| Doctor Name: | JACQUELINE K BRENIZER |
| NPI Number: | 1689838765 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SAC |
| License Number: | 15434-131 |
| Business Practice Address: | 24670 State Road 35 70 Suite 1200 Siren, WI - 548724418 |
| Business Phone Number: | 7153497233 |
| Business Fax Number: | 7153497205 |
| Mailing Address: | 24670 State Road 35 70, Suite 1200 SIREN |
| State: | WI |
| Postal Code: | 548724418 |
| Phone Number: | 7153497233 |
| Fax Number: | 7153497205 |
| NPI Enumeration Date: | 07/17/2008 |
| NPI Last Update Date: | 07/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 15434-131 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |