Provider Demographics
NPI:1225329576
Name:HORNBUCKLE, BRENNA A (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:A
Last Name:HORNBUCKLE
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 1:1407 ABRAHAM DR
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-9096
Mailing Address - Country:US
Mailing Address - Phone:479-524-9533
Mailing Address - Fax:
Practice Address - Street 1:1407 ABRAHAM DR
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-9096
Practice Address - Country:US
Practice Address - Phone:479-524-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist