Provider Demographics
NPI:1881367068
Name:MURRAY-BAIN, BRENNA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:MURRAY-BAIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:730 WILLIAMSON ST APT 327
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4642
Mailing Address - Country:US
Mailing Address - Phone:513-497-0952
Mailing Address - Fax:
Practice Address - Street 1:1500 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2280
Practice Address - Country:US
Practice Address - Phone:608-263-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5307-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist