Provider Demographics
NPI:1578055695
Name:BRANDENBURG, VASTI ESTHER (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VASTI
Middle Name:ESTHER
Last Name:BRANDENBURG
Suffix:
Gender:
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 E CLEARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3124
Mailing Address - Country:US
Mailing Address - Phone:352-359-6157
Mailing Address - Fax:
Practice Address - Street 1:454 E CLEARVIEW AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3124
Practice Address - Country:US
Practice Address - Phone:352-359-6157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH15132OtherOHIO SPEECH & HEARING PROFESSIONALS BOARD