Provider Demographics
NPI:1336891175
Name:ROCHE, BRENNA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:ROCHE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-9527
Mailing Address - Country:US
Mailing Address - Phone:570-862-1131
Mailing Address - Fax:
Practice Address - Street 1:207 ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444-9527
Practice Address - Country:US
Practice Address - Phone:570-862-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASLO15361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist