Provider Demographics
NPI:1366608598
Name:NIXON, BRENDA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:NIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ROPER MOUNTAIN ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4825
Mailing Address - Country:US
Mailing Address - Phone:864-236-1756
Mailing Address - Fax:
Practice Address - Street 1:230 ROPER MOUNTAIN ROAD EXT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4825
Practice Address - Country:US
Practice Address - Phone:864-236-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4358235Z00000X
NY005079-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist