Provider Demographics
NPI:1962852426
Name:DUDDING, BRENDA RENA
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:RENA
Last Name:DUDDING
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 1:711 W LITTLE GARNER RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-7508
Mailing Address - Country:US
Mailing Address - Phone:606-923-5093
Mailing Address - Fax:
Practice Address - Street 1:711 W LITTLE GARNER RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-7508
Practice Address - Country:US
Practice Address - Phone:606-923-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000071867222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist