Provider Demographics
NPI:1821147570
Name:BRENNING, MARYBETH (MA COMMUNICATIVE DIS)
Entity Type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:
Last Name:BRENNING
Suffix:
Gender:F
Credentials:MA COMMUNICATIVE DIS
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:BRENNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:383 JUNIPER AVE.
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950
Mailing Address - Country:US
Mailing Address - Phone:831-241-0297
Mailing Address - Fax:
Practice Address - Street 1:80 GARDEN ST.
Practice Address - Street 2:STE CHOICE HOME HEALTH CARE
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-645-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist