Mrs Traci Breniser Wilson, MA LLP | |
225 South Main St, Suite B, Brooklyn, MI 49230 | |
(517) 414-0065 | |
Not Available |
Full Name | Mrs Traci Breniser Wilson |
---|---|
Gender | Female |
Speciality | Psychologist |
Location | 225 South Main St, Brooklyn, Michigan |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1750304291 | NPI | - | NPPES |
204862865 | Other | MI | TAX ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103T00000X | Psychologist | TH008036 (Michigan) | Primary |
Entity Name | Iha Health Services Corporation |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1457408965 PECOS PAC ID: 2466351440 Enrollment ID: O20040108000355 |
Entity Name | Chelsea Community Hospital |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1912947409 PECOS PAC ID: 0648171074 Enrollment ID: O20040119000004 |
Mailing Address | Practice Location Address |
---|---|
Mrs Traci Breniser Wilson, MA LLP 124 Nicole Dr, Brooklyn, MI 49230 Ph: (517) 414-0065 | Mrs Traci Breniser Wilson, MA LLP 225 South Main St, Suite B, Brooklyn, MI 49230 Ph: (517) 414-0065 |
Mr. Leonard Joseph Gallagher Ii, PHYD Psychologist Medicare: Medicare Enrolled Practice Location: 451 Marshall St, Brooklyn, MI 49230 Phone: 517-414-0697 Fax: 517-938-5914 | |
Sabrina R Corbin, LLP Psychologist Medicare: Accepting Medicare Assignments Practice Location: 119 Bingham Dr, Brooklyn, MI 49230 Phone: 517-402-4008 |