Healthcare Provider Details

I. General information

NPI: 1982880886
Provider Name (Legal Business Name): MEREDITH ANN BRENNAN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEREDITH ANN HASWELL M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N CLEMENT AVE
RAVENA NY
12143-1909
US

IV. Provider business mailing address

12 N CLEMENT AVE
RAVENA NY
12143-1909
US

V. Phone/Fax

Practice location:
  • Phone: 518-669-4285
  • Fax:
Mailing address:
  • Phone: 518-669-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number013234-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: