Provider Demographics
NPI:1053985952
Name:BREZDEN, CONSTANCE MAYA
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:MAYA
Last Name:BREZDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 W PEBBLE BEACH CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4209
Mailing Address - Country:US
Mailing Address - Phone:407-766-6229
Mailing Address - Fax:
Practice Address - Street 1:1172 W OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7515
Practice Address - Country:US
Practice Address - Phone:689-204-2221
Practice Address - Fax:689-204-2225
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ12167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist