Provider Demographics
NPI:1568615771
Name:BRENNAN, LINDA E (SPEECH PATHOLOGIST M)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-0330
Mailing Address - Country:US
Mailing Address - Phone:607-563-2706
Mailing Address - Fax:
Practice Address - Street 1:824 CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-0330
Practice Address - Country:US
Practice Address - Phone:607-563-2706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003555-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist