Provider Demographics
NPI:1629767264
Name:MOEN, BRENNA RAE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:RAE
Last Name:MOEN
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 1:950 OFFICE PARK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2548
Mailing Address - Country:US
Mailing Address - Phone:515-368-1440
Mailing Address - Fax:
Practice Address - Street 1:950 OFFICE PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2548
Practice Address - Country:US
Practice Address - Phone:515-224-0979
Practice Address - Fax:515-224-6090
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114981235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist