Provider Demographics
NPI:1568864486
Name:BRICHER, JENALI M (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENALI
Middle Name:M
Last Name:BRICHER
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:JENALI
Other - Middle Name:M
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8705 NAUTICAL BAY LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3502
Mailing Address - Country:US
Mailing Address - Phone:614-886-1219
Mailing Address - Fax:
Practice Address - Street 1:8705 NAUTICAL BAY LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3502
Practice Address - Country:US
Practice Address - Phone:614-886-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3197420235Z00000X
NVSP-2053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist