Healthcare Provider Details

I. General information

NPI: 1730589532
Provider Name (Legal Business Name): BRENDA ABEL MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14236 N 5TH E
IDAHO FALLS ID
83401-5140
US

IV. Provider business mailing address

14236 N 5TH E
IDAHO FALLS ID
83401-5140
US

V. Phone/Fax

Practice location:
  • Phone: 208-221-1094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-2122
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: