Provider Information for 1124720123
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ANNAMAY BREANN PAYTEN LPC
Other Names:Former Name:BRENDA LEE BLOCKSex: Female
NPI: 1124720123
Last Updated: 2025-01-15
Certification Date: 2025-01-15
Certification Date: 2025-01-15
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1124720123 | ||||||||||||
| Enumeration Date | 2023-03-21 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 88 GUINDON BLVD FOND DU LAC, WI 54935-5866 United States Phone: 920-318-3282 | Fax: | ||||||||||||
| Primary Practice Address | 88 GUINDON BLVD FOND DU LAC, WI 54935-5866 United States Phone: 920-318-3282 | Fax: | ||||||||||||
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