Provider Demographics
NPI:1063861599
Name:NELSON, BRENDA L
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 SWIFT BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3524
Mailing Address - Country:US
Mailing Address - Phone:509-942-3178
Mailing Address - Fax:509-942-2534
Practice Address - Street 1:780 SWIFT BLVD STE 301
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3524
Practice Address - Country:US
Practice Address - Phone:509-942-3178
Practice Address - Fax:509-942-2534
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60550828237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist