Provider Demographics
NPI:1487191771
Name:BRANT, JENNA LEIGH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH
Last Name:BRANT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 MAIN ST APT 207
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1530
Mailing Address - Country:US
Mailing Address - Phone:814-715-1058
Mailing Address - Fax:
Practice Address - Street 1:8580 VERREE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-1370
Practice Address - Country:US
Practice Address - Phone:215-214-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009292235Z00000X
PASL013470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist