Provider Demographics
NPI:1245515980
Name:DEVEREAUX, BRENDA (MS CCC-A)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:DEVEREAUX
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-A
Mailing Address - Street 1:212 W 520 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4695
Mailing Address - Country:US
Mailing Address - Phone:801-221-1220
Mailing Address - Fax:801-515-0708
Practice Address - Street 1:212 W 520 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4695
Practice Address - Country:US
Practice Address - Phone:801-221-1220
Practice Address - Fax:801-515-0708
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT359436-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist