Provider Demographics
NPI:1518335983
Name:BATES, BRIANNA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:BATES
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:PO BOX 72481
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-2481
Mailing Address - Country:US
Mailing Address - Phone:907-415-9331
Mailing Address - Fax:907-600-5065
Practice Address - Street 1:1231 NOBLE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4926
Practice Address - Country:US
Practice Address - Phone:907-415-9331
Practice Address - Fax:907-600-5065
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK144948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist