Healthcare Provider Details

I. General information

NPI: 1023926391
Provider Name (Legal Business Name): ELIZABETH JANE BRANDOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 GLENRIDGE DR
CARMICHAEL CA
95608-2043
US

IV. Provider business mailing address

5897 CHRIS DR
SAN JOSE CA
95123-3534
US

V. Phone/Fax

Practice location:
  • Phone: 916-867-2094
  • Fax:
Mailing address:
  • Phone: 408-802-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number35969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: