Provider Demographics
NPI:1649751702
Name:BRINKMAN, JEAN (SLP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:BRINKMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 TEALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-3354
Mailing Address - Country:US
Mailing Address - Phone:903-720-3321
Mailing Address - Fax:
Practice Address - Street 1:325 TEALWOOD DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-3354
Practice Address - Country:US
Practice Address - Phone:903-720-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist