Provider Demographics
NPI:1467860023
Name:ROSENTHAL, BRENDA SUSAN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUSAN
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BARNETTE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4502
Mailing Address - Country:US
Mailing Address - Phone:907-456-4003
Mailing Address - Fax:907-456-6124
Practice Address - Street 1:1020 BARNETTE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4502
Practice Address - Country:US
Practice Address - Phone:907-456-4003
Practice Address - Fax:907-456-6124
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist