Provider Demographics
NPI:1699909895
Name:BALDEON, BRENDA (SLPD, CCC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BALDEON
Suffix:
Gender:F
Credentials:SLPD, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 CHATTERTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744
Mailing Address - Country:US
Mailing Address - Phone:626-715-2361
Mailing Address - Fax:
Practice Address - Street 1:631 CHATTERTON AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-4907
Practice Address - Country:US
Practice Address - Phone:626-715-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist