Provider Demographics
NPI:1396633806
Name:STEPHENSON, BRENDA BAILEY
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:BAILEY
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:BAILEY
Other - Last Name:SHANKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2522 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4002
Mailing Address - Country:US
Mailing Address - Phone:318-795-3388
Mailing Address - Fax:318-795-3399
Practice Address - Street 1:2522 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4002
Practice Address - Country:US
Practice Address - Phone:318-795-3388
Practice Address - Fax:318-795-3399
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist