Provider Demographics
NPI:1427339100
Name:BREN, NICOLE DENISE (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DENISE
Last Name:BREN
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 VALIANT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1438
Mailing Address - Country:US
Mailing Address - Phone:631-236-5214
Mailing Address - Fax:
Practice Address - Street 1:24 VALIANT DR
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1438
Practice Address - Country:US
Practice Address - Phone:631-236-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012258-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist