Provider Demographics
NPI:1093205536
Name:MELVIN, BRENNA DANIELLE (AUD)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:DANIELLE
Last Name:MELVIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:DANIELLE MELVIN
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:3328 CHURN CREEK RD STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2535
Mailing Address - Country:US
Mailing Address - Phone:530-221-7380
Mailing Address - Fax:530-221-7319
Practice Address - Street 1:3328 CHURN CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2535
Practice Address - Country:US
Practice Address - Phone:530-221-7380
Practice Address - Fax:530-221-7319
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHTL10211237600000X
CAAU3578231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500749995Medicaid