Provider Demographics
NPI:1265868095
Name:BRENTANA, JYL (MS, ATR-BC)
Entity type:Individual
Prefix:MS
First Name:JYL
Middle Name:
Last Name:BRENTANA
Suffix:
Gender:F
Credentials:MS, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2178
Mailing Address - Country:US
Mailing Address - Phone:414-520-1770
Mailing Address - Fax:
Practice Address - Street 1:2120 PATRICIA LN
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2178
Practice Address - Country:US
Practice Address - Phone:414-520-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor