Provider Demographics
NPI:1619029360
Name:BRINER, VANESSA ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:BRINER
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 1:413 BAYNE RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-6066
Mailing Address - Country:US
Mailing Address - Phone:501-467-0541
Mailing Address - Fax:501-429-2124
Practice Address - Street 1:413 BAYNE RD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-6066
Practice Address - Country:US
Practice Address - Phone:501-467-0541
Practice Address - Fax:501-429-2124
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156819721Medicaid