Provider Demographics
NPI:1669697967
Name:SCHILLING, BRENDA JEAN (MA)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JEAN
Last Name:SCHILLING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 SHORE FRONT PKWY APT 7P
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2766
Mailing Address - Country:US
Mailing Address - Phone:718-318-7825
Mailing Address - Fax:
Practice Address - Street 1:10200 SHORE FRONT PKWY APT 7P
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2766
Practice Address - Country:US
Practice Address - Phone:718-318-7825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008219235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist