Provider Demographics
NPI:1407917677
Name:BRISENDINE, TRAEANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRAEANNE
Middle Name:
Last Name:BRISENDINE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:TRAE
Other - Middle Name:
Other - Last Name:BRISENDINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:9805 FENWICK CT
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8687
Mailing Address - Country:US
Mailing Address - Phone:479-649-7465
Mailing Address - Fax:
Practice Address - Street 1:1801 S 74TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2814
Practice Address - Country:US
Practice Address - Phone:479-478-5570
Practice Address - Fax:479-478-5567
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist