Brenda Rena Deadwyler

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP8247 Issued in CA

Practice address

568 Bellevue Ave
Santa Rosa, CA 95407-7741

Phone

(310) 766-4747

NPI assigned

May 10, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1518541085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 BELLEVUE AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954077741",
            "telephone_number": "310-766-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "568 BELLEVUE AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954077741",
            "telephone_number": "310-766-4747"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5704 Shenandoah Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900561045",
            "country_code": "US",
            "telephone_number": "310-766-4747",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEADWYLER",
        "first_name": "BRENDA",
        "middle_name": "RENA",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-10",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP8247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "bexpressiveinc@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "568 Bellevue Ave",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954077741",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "bexpressiveinc@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "address_1": "5704 Shenandoah Ave",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900561045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rudolpho Eduardo De la O, RAS
• De la Rosa Psychotherapists, a MFT Corporation
• Tatra-Li De la Rosa
• Jennifer De Los Santos
• Jake Lee De Souza
• Breanna Dean
• Donald Wayne Dean Jr.
• Marcia Lynn Dean
• Matthew Scott Dean, B.A., B.S., A.A.
• Kaitlin Deasy, RN

• Speech-Language Pathologist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.