Provider Demographics
NPI:1447330212
Name:DORAIS, BRENDA MARCUS (MS, CCC-SLP/A)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MARCUS
Last Name:DORAIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3436
Mailing Address - Country:US
Mailing Address - Phone:856-627-9817
Mailing Address - Fax:
Practice Address - Street 1:524 NORTHWEST BOULEVARD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-2845
Practice Address - Country:US
Practice Address - Phone:856-405-4325
Practice Address - Fax:856-794-5712
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YB00004500231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ235301Medicare UPIN