Provider Demographics
NPI:1235818121
Name:BRESTER, MAKENNA JO
Entity Type:Individual
Prefix:
First Name:MAKENNA
Middle Name:JO
Last Name:BRESTER
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 1:625 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68002-3096
Mailing Address - Country:US
Mailing Address - Phone:402-317-8412
Mailing Address - Fax:
Practice Address - Street 1:5412 83RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3438
Practice Address - Country:US
Practice Address - Phone:402-317-8412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist