Provider Demographics
NPI:1255509360
Name:HUBLY-SUSHKA, BRENDA MARIE (MS-CCC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:HUBLY-SUSHKA
Suffix:
Gender:F
Credentials:MS-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8537 PRAIRIE TRL
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-5709
Mailing Address - Country:US
Mailing Address - Phone:309-530-3722
Mailing Address - Fax:
Practice Address - Street 1:8537 PRAIRIE TRL
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-5709
Practice Address - Country:US
Practice Address - Phone:309-530-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist