Provider Demographics
NPI:1295989861
Name:BARDASIAN, BRENDA LEIGH (MS, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEIGH
Last Name:BARDASIAN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:LEIGH
Other - Last Name:REICHSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:11775 EDUCATION ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2453
Mailing Address - Country:US
Mailing Address - Phone:530-344-2000
Mailing Address - Fax:530-344-2014
Practice Address - Street 1:11775 EDUCATION ST
Practice Address - Street 2:SUITE 102
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2453
Practice Address - Country:US
Practice Address - Phone:530-344-2000
Practice Address - Fax:530-344-2014
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1653231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist