Provider Demographics
NPI:1447772298
Name:PRICE, BRENNA CAMILLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:CAMILLE
Last Name:PRICE
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 1:4771 SUNRISE CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9299
Mailing Address - Country:US
Mailing Address - Phone:505-860-1485
Mailing Address - Fax:
Practice Address - Street 1:4771 SUNRISE CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-9299
Practice Address - Country:US
Practice Address - Phone:505-860-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist