Provider Demographics
NPI:1417166323
Name:BRANDRETH, SHIRLEY E (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:E
Last Name:BRANDRETH
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 1:101 BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2724
Mailing Address - Country:US
Mailing Address - Phone:401-828-4029
Mailing Address - Fax:
Practice Address - Street 1:101 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2724
Practice Address - Country:US
Practice Address - Phone:401-828-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist