Provider Demographics
NPI:1326490053
Name:NEDVED, BRENDA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:NEDVED
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 1:211 S POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-1845
Mailing Address - Country:US
Mailing Address - Phone:605-773-7300
Mailing Address - Fax:
Practice Address - Street 1:211 S POPLAR AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-1845
Practice Address - Country:US
Practice Address - Phone:605-773-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD110-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist