Provider Demographics
NPI:1043690159
Name:WOODRUFF, BRENNA SCHLAEGEL (BCBA)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:SCHLAEGEL
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12423 DONAHOO RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-3140
Mailing Address - Country:US
Mailing Address - Phone:785-425-8091
Mailing Address - Fax:
Practice Address - Street 1:12423 DONAHOO RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-3140
Practice Address - Country:US
Practice Address - Phone:785-425-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00449103K00000X
MO2017025683103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst