Provider Demographics
NPI:1164938643
Name:NESSELROAD, BRENDA CARMELENE (MED, BA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:CARMELENE
Last Name:NESSELROAD
Suffix:
Gender:F
Credentials:MED, BA, CCC-SLP
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:CARMELENE
Other - Last Name:NESSELROAD-SLABY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BA, CCC-SLP
Mailing Address - Street 1:9631 WATERFORD PL.
Mailing Address - Street 2:APT. 208
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140
Mailing Address - Country:US
Mailing Address - Phone:513-484-2265
Mailing Address - Fax:
Practice Address - Street 1:9631 WATERFORD PL.
Practice Address - Street 2:APT. 208
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140
Practice Address - Country:US
Practice Address - Phone:513-484-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist