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NPI Code Detail

MEDICARE: BRENDA LIDDLE SLP

MEDICARE: BRENDA LIDDLE SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist7924MN

General Provider Information

NPI Number : 1619978947
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA LIDDLE SLP
Provider Business Mailing Address
First Line : 4808 VALLEY VIEW RD
Second Line :
City : EDINA
State : MN
Zip : 55424-1754
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4010 W 65TH ST
Second Line : SUITE 105
City : EDINA
State : MN
Zip : 55435-1721
Country : US
Telephone Number : 952-285-2840
Fax Number : 952-285-2830
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 07/08/2007

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Directions to “ BRENDA LIDDLE SLP” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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