Provider Demographics
NPI:1689357485
Name:BRANDENBERGER, TAYLOR JORDAN
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JORDAN
Last Name:BRANDENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 W CHESTNUT ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5202
Mailing Address - Country:US
Mailing Address - Phone:316-708-8395
Mailing Address - Fax:
Practice Address - Street 1:1235 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9829
Practice Address - Country:US
Practice Address - Phone:847-604-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist