Provider Demographics
NPI:1831897461
Name:WETHINGTON, BRENDA MACAYLA (CF SLP)
Entity type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:MACAYLA
Last Name:WETHINGTON
Suffix:
Gender:F
Credentials:CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 JEFFERSON SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1795
Mailing Address - Country:US
Mailing Address - Phone:706-201-8541
Mailing Address - Fax:
Practice Address - Street 1:1308 JEFFERSON SQUARE CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1795
Practice Address - Country:US
Practice Address - Phone:706-201-8541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist