Individual
MISS MARY T BRENNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, SLP
Contact information
Practice address
5577 VANBARR PLACE, SUITE 7, FREELAND, WA 98249
(360) 331-8001
(360) 331-8001
Mailing address
PO BOX 1452, 5577 VANBARR PLACE, SUITE 7, FREELAND, WA 98249-1452
(360) 331-8001
(360) 331-8009
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL00003055
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
364584100000
PREMERA BLUE CROSS
WA
01
—
5388BR
REGENCE PROVIDER NUMBER
WA
05
—
7028319
—
WA
01
—
7101821
AETNA PROVIDER NUMBER
WA
05
—
8454814
—
WA
Enumeration date
11/28/2006
Last updated
12/03/2008
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