Provider Demographics
NPI:1417070269
Name:RENTERIA, BRENDA LYNN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LYNN
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 FOUNTAIN PLAZA BLVD.
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-316-3627
Mailing Address - Fax:956-381-9660
Practice Address - Street 1:2805 FOUNTAIN PLAZA BLVD.
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-316-3627
Practice Address - Fax:956-381-9660
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219141301Medicaid