Provider Demographics
NPI:1093952574
Name:CHAPPELL, BRENDA MARIE (MA-CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MARIE
Last Name:CHAPPELL
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-CCC/SLP
Mailing Address - Street 1:126 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1606
Mailing Address - Country:US
Mailing Address - Phone:425-686-4036
Mailing Address - Fax:206-826-1197
Practice Address - Street 1:210 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1774
Practice Address - Country:US
Practice Address - Phone:866-812-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006669235Z00000X
235Z00000X
WASI60030945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL60109809OtherWASHINGTON LICENSE