Provider Demographics
NPI:1538100151
Name:BRADY, BRENENE MARIE (MS CCC-A)
Entity Type:Individual
Prefix:MS
First Name:BRENENE
Middle Name:MARIE
Last Name:BRADY
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 DIVISION ST
Mailing Address - Street 2:SUITE # 509
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1182
Mailing Address - Country:US
Mailing Address - Phone:815-941-4700
Mailing Address - Fax:815-941-4700
Practice Address - Street 1:1802 DIVISION ST
Practice Address - Street 2:SUITE # 509
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1182
Practice Address - Country:US
Practice Address - Phone:815-941-4700
Practice Address - Fax:815-941-4700
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212381Medicare ID - Type UnspecifiedPART B PROVIDER