Provider Demographics
NPI:1649599739
Name:DALE, BRANDY M (CPRS, ST-C, STNA)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:DALE
Suffix:
Gender:F
Credentials:CPRS, ST-C, STNA
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 703
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45071-0703
Mailing Address - Country:US
Mailing Address - Phone:513-886-6506
Mailing Address - Fax:
Practice Address - Street 1:7985 MILL CREEK CIR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5806
Practice Address - Country:US
Practice Address - Phone:513-668-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X, 374700000X, 3747P1801X, 374U00000X, 171M00000X
OH0001415175T00000X
OH400865580209376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No175T00000XOther Service ProvidersPeer Specialist
No374700000XNursing Service Related ProvidersTechnician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide