Provider Demographics
NPI:1881842680
Name:TOLBERT, BRENDA J (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 AUGUSTA MANOR CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-3475
Mailing Address - Country:US
Mailing Address - Phone:314-368-1848
Mailing Address - Fax:
Practice Address - Street 1:777 SOUTH NEW BALLAS ROAD
Practice Address - Street 2:SUITE 320E
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8789
Practice Address - Country:US
Practice Address - Phone:314-567-4868
Practice Address - Fax:314-567-7639
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01429237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter