Provider Demographics
NPI:1912392929
Name:BREWER, BRANDON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:BREWER
Suffix:
Gender:M
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 1:1306 QUINTERO ST
Mailing Address - Street 2:APT. 11
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-6965
Mailing Address - Country:US
Mailing Address - Phone:520-444-8487
Mailing Address - Fax:
Practice Address - Street 1:1306 QUINTERO ST
Practice Address - Street 2:APT. 11
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-6965
Practice Address - Country:US
Practice Address - Phone:520-444-8487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist