Provider Demographics
NPI:1255690632
Name:BRENNER, ANJELA R (CFSLP)
Entity Type:Individual
Prefix:
First Name:ANJELA
Middle Name:R
Last Name:BRENNER
Suffix:
Gender:F
Credentials:CFSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2304
Mailing Address - Country:US
Mailing Address - Phone:617-462-5185
Mailing Address - Fax:
Practice Address - Street 1:54 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2304
Practice Address - Country:US
Practice Address - Phone:617-462-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-06
Last Update Date:2012-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist