Provider Demographics
NPI:1952067746
Name:ECKLUND, BRANDI LYN
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LYN
Last Name:ECKLUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 URSULINES AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-4243
Mailing Address - Country:US
Mailing Address - Phone:318-235-0524
Mailing Address - Fax:
Practice Address - Street 1:4501 E AMES BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-6333
Practice Address - Country:US
Practice Address - Phone:504-762-8569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist