Provider Demographics
NPI:1235310582
Name:SKARIN, BRENDA DUDLEY (CCC/SP)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:DUDLEY
Last Name:SKARIN
Suffix:
Gender:F
Credentials:CCC/SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4551
Mailing Address - Country:US
Mailing Address - Phone:630-231-5377
Mailing Address - Fax:
Practice Address - Street 1:4 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4551
Practice Address - Country:US
Practice Address - Phone:630-357-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist