Provider Demographics
NPI:1306025986
Name:GIVAN, BRANDY DAWN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:DAWN
Last Name:GIVAN
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 1:565 CONGRESS DR
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2880
Mailing Address - Country:US
Mailing Address - Phone:270-307-2755
Mailing Address - Fax:
Practice Address - Street 1:565 CONGRESS DR
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2880
Practice Address - Country:US
Practice Address - Phone:270-307-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist