Provider Demographics
NPI:1134278617
Name:DUBRE, BRAINA MICHELLE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRAINA
Middle Name:MICHELLE
Last Name:DUBRE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:PRIVETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC/SLP
Mailing Address - Street 1:310 WINDWARD WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3834
Mailing Address - Country:US
Mailing Address - Phone:501-231-9305
Mailing Address - Fax:864-528-5541
Practice Address - Street 1:30 SPRINGCREST CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2930
Practice Address - Country:US
Practice Address - Phone:502-315-4414
Practice Address - Fax:501-315-3467
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161298721Medicaid