Provider Demographics
NPI:1417092164
Name:BRAWNER, KRISSY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISSY
Middle Name:
Last Name:BRAWNER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KEARSTIN
Other - Middle Name:
Other - Last Name:BRAWNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1629 FOXCROFT DR E
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5616
Mailing Address - Country:US
Mailing Address - Phone:727-787-4252
Mailing Address - Fax:
Practice Address - Street 1:4902 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-4033
Practice Address - Country:US
Practice Address - Phone:727-592-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist