Provider Demographics
NPI:1962853580
Name:BECK, BRENDA MARIE (CAMT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:BECK
Suffix:
Gender:F
Credentials:CAMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 BROOKWAY CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4274
Mailing Address - Country:US
Mailing Address - Phone:907-575-4321
Mailing Address - Fax:
Practice Address - Street 1:8601 BROOKWAY CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4274
Practice Address - Country:US
Practice Address - Phone:907-575-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101347174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist