Provider Demographics
NPI:1043310758
Name:BRAMMER, REBECCA LEEANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEEANNE
Last Name:BRAMMER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 COOLVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1009
Mailing Address - Country:US
Mailing Address - Phone:304-669-0201
Mailing Address - Fax:
Practice Address - Street 1:12 COOLVIEW LN
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1009
Practice Address - Country:US
Practice Address - Phone:304-669-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005152Medicaid