Provider Demographics
NPI:1093045445
Name:ROTHER, BRENDA T (MACCCSLP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:T
Last Name:ROTHER
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:JANE
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCCSLP
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2024
Practice Address - Street 1:70 STOCKTON AVE
Practice Address - Street 2:
Practice Address - City:OCEAN GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07756-1150
Practice Address - Country:US
Practice Address - Phone:732-774-4316
Practice Address - Fax:732-776-6313
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00326800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist