Provider Demographics
NPI:1245583012
Name:MILLS, BRANDI RENE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:RENE
Last Name:MILLS
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 1:3709 GROOMS ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1626
Mailing Address - Country:US
Mailing Address - Phone:512-808-3953
Mailing Address - Fax:
Practice Address - Street 1:6448 E HIGHWAY 290 STE E106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1041
Practice Address - Country:US
Practice Address - Phone:512-808-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005706A235Z00000X
TN4562235Z00000X
TX111277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist