Active NPI
Brande Gwen Van Brocklin, M.A. CCC-SLP
- Speech-Language Pathologist
- Los Banos, CA
National Provider Identifier
1316743016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 33487
- Practice address
- 633 Monroe Ave
Los Banos, CA 93635-4718 - Phone
- (619) 756-8070
- NPI assigned
- Feb 22, 2025
- Sex
- Female
- Sole proprietor
- No
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 | 33487 | CA | Primary |
Addresses
Primary practice location
633 Monroe Ave
Los Banos, CA 93635-4718
Mailing address
633 Monroe Ave
Los Banos, CA 93635-4718
Phone (619) 756-8070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250404001625 | CA | Practitioner - Qualified Speech Language Pathologist | 5799209326 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1740182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740182400000",
"number": "1316743016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "633 MONROE AVE",
"city": "LOS BANOS",
"state": "CA",
"postal_code": "936354718",
"telephone_number": "619-756-8070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 MONROE AVE",
"city": "LOS BANOS",
"state": "CA",
"postal_code": "936354718",
"telephone_number": "619-756-8070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN BROCKLIN",
"first_name": "BRANDE",
"middle_name": "GWEN",
"name_prefix": "Ms.",
"credential": "M.A. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-02-22",
"last_updated": "2025-02-22",
"certification_date": "2025-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "33487",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Banos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.