MEDICARE: MRS. CHAYA BRENNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	6376	MD

General Provider Information

NPI Number	:	1003113754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHAYA BRENNER

Provider Business Mailing Address
First Line	:	3608 BANCROFT RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3227
Country	:	US
Telephone Number	:	410-358-1997
Fax Number	:	866-840-6040

Provider Business Practice Location Address
First Line	:	6414 PARK HTS
Second Line	:	SUITE T1
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3055
Country	:	US
Telephone Number	:	410-318-8561
Fax Number	:	866-840-6040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	02/15/2011

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Directions to “ MRS. CHAYA BRENNER ” Practice Location

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