Provider Demographics
NPI:1720200785
Name:EISELE, BRENDA DENISE (MA, SLP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:DENISE
Last Name:EISELE
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 NOBLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130
Mailing Address - Country:US
Mailing Address - Phone:734-424-0694
Mailing Address - Fax:
Practice Address - Street 1:3630 NOBLE DRIVE
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130
Practice Address - Country:US
Practice Address - Phone:734-424-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist