Provider Demographics
NPI:1407271604
Name:DUGGAN, BRENDA JURGENSON (SPEECH/LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JURGENSON
Last Name:DUGGAN
Suffix:
Gender:F
Credentials:SPEECH/LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8690 MARY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9110
Mailing Address - Country:US
Mailing Address - Phone:734-847-6217
Mailing Address - Fax:
Practice Address - Street 1:8690 MARY MEADOWS DR
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-9110
Practice Address - Country:US
Practice Address - Phone:734-847-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 6911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP 6911Medicaid