Healthcare Provider Details

I. General information

NPI: 1750392635
Provider Name (Legal Business Name): BRENDA JEAN DOEKSEN M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15151 W CENTERRA DR S
GOODYEAR AZ
85338-2956
US

IV. Provider business mailing address

10943 S DREAMY DR
GOODYEAR AZ
85338-9622
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-4800
  • Fax:
Mailing address:
  • Phone: 623-374-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP2080
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: