Provider Demographics
NPI:1053003426
Name:CAIN, BRENNAN NICOLE (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:BRENNAN
Middle Name:NICOLE
Last Name:CAIN
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11978 DONLIN DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6210
Mailing Address - Country:US
Mailing Address - Phone:207-604-4040
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAKE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3010
Practice Address - Country:US
Practice Address - Phone:561-485-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist