Provider Demographics
NPI:1083058234
Name:SMITH, BRIANNA LYNN (SLPA)
Entity Type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16052 BEACH BLVD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3801
Mailing Address - Country:US
Mailing Address - Phone:714-916-0641
Mailing Address - Fax:
Practice Address - Street 1:16052 BEACH BLVD
Practice Address - Street 2:SUITE 135
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3801
Practice Address - Country:US
Practice Address - Phone:714-916-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21982355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant