Provider Demographics
NPI:1467093773
Name:BRANNON, CHRISTI ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTI
Middle Name:ANN
Last Name:BRANNON
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 1:3801 E HIGHWAY 98 STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-5318
Mailing Address - Country:US
Mailing Address - Phone:850-229-5752
Mailing Address - Fax:850-229-5753
Practice Address - Street 1:166 RUSTY GANS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-4510
Practice Address - Country:US
Practice Address - Phone:989-619-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist