Provider Demographics
NPI:1023238508
Name:BRUMBAUGH, BRENDA SUE (SLP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SUE
Last Name:BRUMBAUGH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13730 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220-9506
Mailing Address - Country:US
Mailing Address - Phone:701-265-8788
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST. EAST
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220
Practice Address - Country:US
Practice Address - Phone:701-265-8417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND107OtherND LICENSE FOR SLP
ND58571Medicaid