Provider Demographics
NPI:1720326663
Name:OGRODNICK, BRENDA H (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:H
Last Name:OGRODNICK
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 1:125 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1222
Mailing Address - Country:US
Mailing Address - Phone:732-299-7530
Mailing Address - Fax:
Practice Address - Street 1:125 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1222
Practice Address - Country:US
Practice Address - Phone:732-299-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00385900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist