Provider Demographics
NPI:1649663642
Name:BRUMBAUGH, BRENDA
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:BRUMBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 LOVERS LN NE
Mailing Address - Street 2:
Mailing Address - City:N CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-1420
Mailing Address - Country:US
Mailing Address - Phone:330-323-0456
Mailing Address - Fax:
Practice Address - Street 1:1951 LOVERS LN NE
Practice Address - Street 2:
Practice Address - City:N CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-1420
Practice Address - Country:US
Practice Address - Phone:330-323-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2451235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist