Provider Demographics
NPI:1811165756
Name:MCCANN, BRENDA JEAN (AUDCCCA)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:JEAN
Last Name:MCCANN
Suffix:
Gender:F
Credentials:AUDCCCA
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:JEAN
Other - Last Name:BECKROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUDCCCA
Mailing Address - Street 1:1806 E PARKDALE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9363
Mailing Address - Country:US
Mailing Address - Phone:231-398-9536
Mailing Address - Fax:231-398-9541
Practice Address - Street 1:1806 E PARKDALE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9363
Practice Address - Country:US
Practice Address - Phone:231-398-9536
Practice Address - Fax:231-398-9541
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000332231HA2500X, 231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540E102660OtherBCBS MICHIGAN
MI640E126000OtherBCBS MICHIGAN