Provider Demographics
NPI:1396306452
Name:PEREZ, BRENDA IVET (SLP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:IVET
Last Name:PEREZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3340
Mailing Address - Country:US
Mailing Address - Phone:214-663-8464
Mailing Address - Fax:
Practice Address - Street 1:7100 N HIGH ST STE 203
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2392
Practice Address - Country:US
Practice Address - Phone:614-505-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist