Provider Demographics
NPI:1245748565
Name:BRAGG, BREE HICKOX (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BREE
Middle Name:HICKOX
Last Name:BRAGG
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8857 HIGHWAY 76 W
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-3706
Mailing Address - Country:US
Mailing Address - Phone:706-224-4575
Mailing Address - Fax:
Practice Address - Street 1:8857 HIGHWAY 76 W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-3706
Practice Address - Country:US
Practice Address - Phone:706-224-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist