1487090692 NPI number — MRS. BRENDA LEE DOUBERLY MS,CCC-SLP

Table of content: MRS. BRENDA LEE DOUBERLY MS,CCC-SLP (NPI 1487090692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487090692 NPI number — MRS. BRENDA LEE DOUBERLY MS,CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOUBERLY
Provider First Name:
BRENDA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS,CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCUE
Provider Other First Name:
BRENDA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487090692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5950 CARMICHAEL PL
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-2348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-262-5744
Provider Business Mailing Address Fax Number:
334-262-5155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5950 CARMICHAEL PL
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117-2348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-262-5744
Provider Business Practice Location Address Fax Number:
334-262-5155
Provider Enumeration Date:
05/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  3442 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com