Provider Demographics
NPI:1760871677
Name:BRENENSTUHL, TASHA M (MA/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:M
Last Name:BRENENSTUHL
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 JOHN KNOX DR
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235-9662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1575 JOHN KNOX DR
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:NC
Practice Address - Zip Code:27235-9662
Practice Address - Country:US
Practice Address - Phone:336-389-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist