Individual
MRS. BRENDA AUDREY BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
321 W. JUNIPER ST, GILBERT, AZ 85233
(480) 892-2805
Mailing address
140 S GILBERT RD, GILBERT, AZ 85296-1016
(480) 545-3826
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLPS5146
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
638710
—
AZ
Enumeration date
12/22/2006
Last updated
07/08/2007
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