Provider Demographics
NPI:1316226947
Name:CHAU, BRENDA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:CHAU
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 ETRIS RD
Mailing Address - Street 2:SUITE A150
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1421
Mailing Address - Country:US
Mailing Address - Phone:770-998-9599
Mailing Address - Fax:770-645-1313
Practice Address - Street 1:12010 ETRIS RD
Practice Address - Street 2:SUITE A150
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1421
Practice Address - Country:US
Practice Address - Phone:770-998-9599
Practice Address - Fax:770-645-1313
Is Sole Proprietor?:No
Enumeration Date:2011-08-13
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist