Provider Demographics
NPI:1215551767
Name:CHISHOLM, BRENDA EDEN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:EDEN
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 ORCUTT DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03036-4069
Mailing Address - Country:US
Mailing Address - Phone:603-401-0844
Mailing Address - Fax:
Practice Address - Street 1:18 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2197
Practice Address - Country:US
Practice Address - Phone:603-432-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist