Provider Demographics
NPI:1336490267
Name:BRYANT, KIRSTAN CAMILLE (SLP)
Entity Type:Individual
Prefix:
First Name:KIRSTAN
Middle Name:CAMILLE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KIRSTAN
Other - Middle Name:CAMILLE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:695 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2472
Mailing Address - Country:US
Mailing Address - Phone:423-622-1551
Mailing Address - Fax:423-622-1556
Practice Address - Street 1:695 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2472
Practice Address - Country:US
Practice Address - Phone:423-622-1551
Practice Address - Fax:423-622-1556
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist