Provider Demographics
NPI:1013645902
Name:BRENNAN, CHANTEL BRENA
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:BRENA
Last Name:BRENNAN
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 1:4839 CAREY DR
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1606
Mailing Address - Country:US
Mailing Address - Phone:315-450-4766
Mailing Address - Fax:
Practice Address - Street 1:5639 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1250
Practice Address - Country:US
Practice Address - Phone:315-468-2985
Practice Address - Fax:315-320-0245
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003099-01231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist