1346596467 NPI number — STEFANIE LEE BRANNAN MS CCC SLP

Table of content: STEFANIE LEE BRANNAN MS CCC SLP (NPI 1346596467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346596467 NPI number — STEFANIE LEE BRANNAN MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANNAN
Provider First Name:
STEFANIE
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOTELO
Provider Other First Name:
STEFANIE
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346596467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1431 FRAUN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89436-9320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-742-8635
Provider Business Mailing Address Fax Number:
775-448-6106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 FRAUN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARKS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89436-9320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-742-8635
Provider Business Practice Location Address Fax Number:
775-448-6106
Provider Enumeration Date:
07/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  1216 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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