Provider Demographics
NPI:1316371644
Name:BRINKE, LUSANA MARIA (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LUSANA
Middle Name:MARIA
Last Name:BRINKE
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 COMPTON RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5112
Mailing Address - Country:US
Mailing Address - Phone:956-222-3759
Mailing Address - Fax:361-937-1180
Practice Address - Street 1:9902 COMPTON RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-5112
Practice Address - Country:US
Practice Address - Phone:956-222-3759
Practice Address - Fax:361-937-1180
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist