Basic Information
| Provider Information | |||||||||
| NPI: | 1396216933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EGGEN | ||||||||
| FirstName: | BRENDAN | ||||||||
| MiddleName: | CORNELIUS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 RAYMA CT | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895035707 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 POLLARD RD | ||||||||
| Address2: | |||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950321438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083786131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2018 | ||||||||
| LastUpdateDate: | 12/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP25557 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.