Provider Demographics
NPI:1619269149
Name:CABLE, BRANDY NICOLE (MA, SLP)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:NICOLE
Last Name:CABLE
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-1025
Mailing Address - Country:US
Mailing Address - Phone:859-779-9394
Mailing Address - Fax:
Practice Address - Street 1:215 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1025
Practice Address - Country:US
Practice Address - Phone:859-779-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11-017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist