Provider Demographics
NPI:1174339576
Name:BRENTON, TAMMIE (LSW)
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:BRENTON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 E STONEWAY DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-6917
Mailing Address - Country:US
Mailing Address - Phone:419-239-6041
Mailing Address - Fax:
Practice Address - Street 1:1535 FIRST ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3901
Practice Address - Country:US
Practice Address - Phone:419-357-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2411705104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker