Provider Demographics
NPI:1114564523
Name:NEILSEN, BRANDI JEAN
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:JEAN
Last Name:NEILSEN
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 1:7407 ESTANCIA LN
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-4738
Mailing Address - Country:US
Mailing Address - Phone:435-757-3689
Mailing Address - Fax:
Practice Address - Street 1:7407 ESTANCIA LN
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84335-4738
Practice Address - Country:US
Practice Address - Phone:435-757-3689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8583840-9937235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist