Healthcare Provider Details

I. General information

NPI: 1043612195
Provider Name (Legal Business Name): BRIANA M. ARENZ M.S. SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8306 SAINT LUKES DR
BEARDSTOWN IL
62618-8384
US

IV. Provider business mailing address

1419 CLAY ST
BEARDSTOWN IL
62618-2017
US

V. Phone/Fax

Practice location:
  • Phone: 217-323-9454
  • Fax:
Mailing address:
  • Phone: 217-473-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146012402
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: