Provider Demographics
NPI:1407502271
Name:BREN, JESSICA (SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BREN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WOODSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1819
Mailing Address - Country:US
Mailing Address - Phone:215-237-8468
Mailing Address - Fax:
Practice Address - Street 1:200 WOODSIDE CIR
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1819
Practice Address - Country:US
Practice Address - Phone:215-237-8468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA32207235Z00000X
AZSLP13508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist