Provider Demographics
NPI:1427367424
Name:BRINEGAR, DORIS ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:ANN
Last Name:BRINEGAR
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 1:8641 FAWN LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-9776
Mailing Address - Country:US
Mailing Address - Phone:219-771-1466
Mailing Address - Fax:
Practice Address - Street 1:8641 FAWN LAKE CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-9776
Practice Address - Country:US
Practice Address - Phone:219-771-1466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-25
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005127A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist