Provider Demographics
NPI:1366125254
Name:BRAIN LIFE CONNECTION LLC
Entity type:Organization
Organization Name:BRAIN LIFE CONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MINAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:508-296-4301
Mailing Address - Street 1:2360 ROUTE 33
Mailing Address - Street 2:STE 112 UNIT #564
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1416
Mailing Address - Country:US
Mailing Address - Phone:508-296-4301
Mailing Address - Fax:
Practice Address - Street 1:4308 STEFANIE DR
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505
Practice Address - Country:US
Practice Address - Phone:508-296-4301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty