Provider Demographics
NPI:1740341916
Name:BRISENDINE SPEECH-LANGUAGE PATHOLOGY, INC.
Entity type:Organization
Organization Name:BRISENDINE SPEECH-LANGUAGE PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRAEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISENDINE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:479-478-5570
Mailing Address - Street 1:9805 FENWICK CT
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8687
Mailing Address - Country:US
Mailing Address - Phone:479-649-7465
Mailing Address - Fax:
Practice Address - Street 1:1801 S 74TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2814
Practice Address - Country:US
Practice Address - Phone:479-478-5570
Practice Address - Fax:479-478-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty