Provider Demographics
NPI:1063882033
Name:GILLAR, BRENDA (CCC/SLP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:GILLAR
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 W LOOP 281
Mailing Address - Street 2:STE100 PMB153
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2571
Mailing Address - Country:US
Mailing Address - Phone:972-935-4752
Mailing Address - Fax:
Practice Address - Street 1:1809 W LOOP 281
Practice Address - Street 2:STE100 PMB153
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2571
Practice Address - Country:US
Practice Address - Phone:972-935-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist