Provider Demographics
NPI:1548529019
Name:BRELLO, JENNIFER MYERS (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MYERS
Last Name:BRELLO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 CARMACK RD
Mailing Address - Street 2:PRESSEY HALL ROOM 139
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1002
Mailing Address - Country:US
Mailing Address - Phone:614-292-6251
Mailing Address - Fax:614-292-5723
Practice Address - Street 1:1070 CARMACK RD
Practice Address - Street 2:PRESSEY HALL ROOM 139
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1002
Practice Address - Country:US
Practice Address - Phone:614-292-6251
Practice Address - Fax:614-292-5723
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP5885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist