Provider Demographics
NPI:1255820684
Name:DULA, BRENDA (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:DULA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-9562
Mailing Address - Country:US
Mailing Address - Phone:336-667-1555
Mailing Address - Fax:336-667-2088
Practice Address - Street 1:697 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-9562
Practice Address - Country:US
Practice Address - Phone:336-667-1555
Practice Address - Fax:336-667-2088
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist