Provider Demographics
NPI:1548436694
Name:BRENNAN, BONNI (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:BONNI
Middle Name:
Last Name:BRENNAN
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 1:227 BROCTON ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3025
Mailing Address - Country:US
Mailing Address - Phone:361-550-0088
Mailing Address - Fax:361-582-4114
Practice Address - Street 1:227 BROCTON ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3025
Practice Address - Country:US
Practice Address - Phone:361-550-0088
Practice Address - Fax:361-582-4114
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist