Provider Demographics
NPI:1982880886
Name:BRENNAN, MEREDITH ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:ANN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:ANN
Other - Last Name:HASWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:12 N CLEMENT AVE
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143-1909
Mailing Address - Country:US
Mailing Address - Phone:518-669-4285
Mailing Address - Fax:
Practice Address - Street 1:12 N CLEMENT AVE
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143-1909
Practice Address - Country:US
Practice Address - Phone:518-669-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013234-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist