Provider Demographics
NPI:1114317302
Name:MCDOWELL, BRENDA (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12733 NADINE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1445
Mailing Address - Country:US
Mailing Address - Phone:586-634-4914
Mailing Address - Fax:
Practice Address - Street 1:12733 NADINE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1445
Practice Address - Country:US
Practice Address - Phone:586-634-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000147231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist