Provider Demographics
NPI:1346872405
Name:DETTMERING, BRIANNE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:
Last Name:DETTMERING
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:MS
Other - First Name:BRIANNE
Other - Middle Name:
Other - Last Name:ZALUSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:88 CARL WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-3366
Mailing Address - Country:US
Mailing Address - Phone:678-315-4259
Mailing Address - Fax:
Practice Address - Street 1:88 CARL WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-3366
Practice Address - Country:US
Practice Address - Phone:678-315-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist