Provider Demographics
NPI:1053540211
Name:BRANDENBURGER, NANCY (SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:BRANDENBURGER
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 QUEEN ANNE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2826
Mailing Address - Country:US
Mailing Address - Phone:410-643-4906
Mailing Address - Fax:
Practice Address - Street 1:1630 MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2791
Practice Address - Country:US
Practice Address - Phone:410-604-2982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist