Provider Demographics
NPI:1043083645
Name:BRAVE SPEECH AND LANGUAGE
Entity Type:Organization
Organization Name:BRAVE SPEECH AND LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:HEATHER
Authorized Official - Last Name:RENFRO
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:406-231-4364
Mailing Address - Street 1:52 32ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-4241
Mailing Address - Country:US
Mailing Address - Phone:406-231-4364
Mailing Address - Fax:
Practice Address - Street 1:52 32ND AVE NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-4241
Practice Address - Country:US
Practice Address - Phone:406-231-4364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty