Individual
MRS. BRENDA M VAN WIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. C.C.C.-SLP
Contact information
Practice address
2142 STATE ROUTE 4, FORT EDWARD, NY 12828-3409
(518) 747-0843
Mailing address
2142 STATE ROUTE 4, FORT EDWARD, NY 12828-3409
(518) 747-0843
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
006161-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006161-1
NEW YORK STATE LICENSE IN SPEECH PATHOLOGY
NY
01
—
01060966
AMERICAN SPEECH AND HEARING ASSOCIATION ASHA
NY
Enumeration date
10/26/2008
Last updated
03/13/2013
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