Provider Demographics
NPI:1003390006
Name:FRANK, BRENDA (CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:FRANK
Suffix:
Gender:F
Credentials:CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W KRAUSE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605-2906
Mailing Address - Country:US
Mailing Address - Phone:309-672-6522
Mailing Address - Fax:309-672-6523
Practice Address - Street 1:2727 W KRAUSE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2906
Practice Address - Country:US
Practice Address - Phone:309-672-6522
Practice Address - Fax:309-672-6523
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist