Provider Demographics
NPI:1760577431
Name:BRENGMAN, CHRISTINE JANET (CCC-A)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JANET
Last Name:BRENGMAN
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 E HOTCHKISS RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2135 BRENNER ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3628
Practice Address - Country:US
Practice Address - Phone:989-791-2100
Practice Address - Fax:989-791-2323
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000030231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4700562Medicaid
MI4700526Medicaid
MI3500137Medicaid