Provider Demographics
NPI:1003241027
Name:BRYANT, TIARA L (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TIARA
Middle Name:L
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 US HIGHWAY 301 N
Mailing Address - Street 2:#195
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-8701
Mailing Address - Country:US
Mailing Address - Phone:941-315-9838
Mailing Address - Fax:941-315-8551
Practice Address - Street 1:8955 US HIGHWAY 301 N
Practice Address - Street 2:#195
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8701
Practice Address - Country:US
Practice Address - Phone:941-315-9838
Practice Address - Fax:941-315-8551
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist