Provider Demographics
NPI:1467179069
Name:PANNOR-BROWN, VIVA
Entity Type:Individual
Prefix:
First Name:VIVA
Middle Name:
Last Name:PANNOR-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E NORTHERN LIGHTS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2730
Mailing Address - Country:US
Mailing Address - Phone:907-222-9905
Mailing Address - Fax:907-222-9925
Practice Address - Street 1:207 E NORTHERN LIGHTS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2730
Practice Address - Country:US
Practice Address - Phone:907-222-9905
Practice Address - Fax:907-222-9925
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK200749235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist