Provider Demographics
NPI:1215169230
Name:BRANDEL, JAYNE MICHELLE (CCC-SLP)
Entity type:Individual
Prefix:PROF
First Name:JAYNE
Middle Name:MICHELLE
Last Name:BRANDEL
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:PO BOX 6122
Mailing Address - Street 2:355 OAKLAND ST.
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-6122
Mailing Address - Country:US
Mailing Address - Phone:304-293-2377
Mailing Address - Fax:304-293-2905
Practice Address - Street 1:355 OAKLAND ST.
Practice Address - Street 2:805 ALLEN HALL
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-6122
Practice Address - Country:US
Practice Address - Phone:304-293-2377
Practice Address - Fax:304-293-2905
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2210235Z00000X
WV1738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
09145096OtherASHA CERTIFICATION