Active NPI
Mary T Brennan, MS, SLP
- Speech-Language Pathologist
- Freeland, WA
National Provider Identifier
1205902244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- LL00003055
- Practice address
- 5577 Vanbarr Place
Suite 7
Freeland, WA 98249 - Phone
- (360) 331-8001
- Fax
- (360) 331-8001
- NPI assigned
- Nov 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | LL00003055 | WA | Primary |
Addresses
Primary practice location
5577 Vanbarr Place
Suite 7
Freeland, WA 98249
Mailing address
PO Box 1452
5577 Vanbarr Place, Suite 7
Freeland, WA 98249-1452
Phone (360) 331-8001
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7028319 | Medicaid | WA | |
| 364584100000 | Other | WA | PREMERA BLUE CROSS |
| 5388BR | Other | WA | REGENCE PROVIDER NUMBER |
| 8454814 | Medicaid | WA | |
| 7101821 | Other | WA | AETNA PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL00003055 | WA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228262400000",
"number": "1205902244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1452",
"address_2": "5577 VANBARR PLACE, SUITE 7",
"city": "FREELAND",
"state": "WA",
"postal_code": "982491452",
"telephone_number": "360-331-8001",
"fax_number": "360-331-8009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5577 VANBARR PLACE",
"address_2": "SUITE 7",
"city": "FREELAND",
"state": "WA",
"postal_code": "98249",
"telephone_number": "360-331-8001",
"fax_number": "360-331-8001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNAN",
"first_name": "MARY",
"middle_name": "T",
"name_prefix": "Miss",
"credential": "MS, SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-28",
"last_updated": "2008-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "LL00003055",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7028319",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA BLUE CROSS",
"identifier": "364584100000",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE PROVIDER NUMBER",
"identifier": "5388BR",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8454814",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROVIDER NUMBER",
"identifier": "7101821",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Freeland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.