Provider Demographics
NPI:1487090692
Name:DOUBERLY, BRENDA LEE (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEE
Last Name:DOUBERLY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:MCCUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5950 CARMICHAEL PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2348
Mailing Address - Country:US
Mailing Address - Phone:334-262-5744
Mailing Address - Fax:334-262-5155
Practice Address - Street 1:5950 CARMICHAEL PL
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2348
Practice Address - Country:US
Practice Address - Phone:334-262-5744
Practice Address - Fax:334-262-5155
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist