Provider Demographics
NPI:1962705129
Name:TRAVIS, BRENDA J (MS)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 LAUREL BOWIE RD
Mailing Address - Street 2:SUITE 205-F
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1703
Mailing Address - Country:US
Mailing Address - Phone:240-245-4370
Mailing Address - Fax:240-245-4472
Practice Address - Street 1:6915 LAUREL-BOWIE ROAD
Practice Address - Street 2:SUITE 205-F
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:240-245-4370
Practice Address - Fax:240-245-4472
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist