Brenna A. Koedam, LMHC, IADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

05041 Issued in IA

Practice address

201 E 11TH St
Spencer, IA 51301-4436

Phone

(800) 242-5101

NPI assigned

Sep 19, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1437409281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E 11TH ST",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014436",
            "telephone_number": "800-242-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E 11TH ST",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014436",
            "telephone_number": "800-242-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEDAM",
        "first_name": "BRENNA",
        "middle_name": "A.",
        "name_prefix": "Mrs.",
        "credential": "LMHC, IADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-19",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "05041",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "001530",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011650",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Robert Keonin, M.D.
• William E Kersting, LISW
• Stephen D Kitchens
• Christian Lynn Kladstrup, DO
• Amber Klynsma, LMSW, TCADC, P-CFLE
• Sherry Lynn Kolacia-Tighe, M.D.
• Yogesh Vinod Kolwadkar, MD,MRCSED,MS,MCH
• Laura Ellen Konkle-King, LMSW
• Travis Kremmin, PHARMD
• Elizabeth C. Kressin, D.C.

• Addiction (Substance Use Disorder) Counselor in Spencer, IA
• Providers in Spencer, IA by specialty
• Addiction (Substance Use Disorder) Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.