Provider Demographics
NPI:1750392635
Name:DOEKSEN, BRENDA JEAN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JEAN
Last Name:DOEKSEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10943 S DREAMY DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9622
Mailing Address - Country:US
Mailing Address - Phone:623-374-4994
Mailing Address - Fax:
Practice Address - Street 1:15151 W CENTERRA DR S
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2956
Practice Address - Country:US
Practice Address - Phone:623-772-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ757320Medicare UPIN